title: Internal abdominal hernia: Intestinal obstruction due to trans-mesenteric hernia containing transverse colon.
abstract: BACKGROUND
  Internal abdominal hernias are infrequent but an increasing cause of bowel obstruction still often underdiagnosed. Among adults its usual causes are congenital anomalies of intestinal rotation, postsurgical iatrogenic, trauma or infection diseases.
  
  
  METHODS
  We report the case of a 63-year-old woman with history of chronic constipation. The patient was hospitalized for two days with acute abdominal pain, abdominal distension and inability to eliminate flatus. The X-ray and abdominal computerized tomography scan (CT scan) showed signs of intestinal obstruction. Exploratory laparotomy performed revealed a trans-mesenteric hernia containing part of the transverse colon. The intestine was viable and resection was not necessary. Only the hernia was repaired.
  
  
  CONCLUSIONS
  Internal trans-mesenteric hernia constitutes a rare type of internal abdominal hernia, corresponding from 0.2 to 0.9% of bowel obstructions. This type carries a high risk of strangulation and even small hernias can be fatal. This complication is specially related to trans-mesenteric hernias as it tends to volvulize. Unfortunately, the clinical diagnosis is rather difficult.
  
  
  CONCLUSIONS
  Trans-mesenteric internal abdominal hernia may be asymptomatic for many years because of its nonspecific symptoms. The role of imaging test is relevant but still does not avoid the necessity of exploratory surgery when clinical features are uncertain.
authors.affiliation: Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.
authors.forename: Brenda
authors.initials: B
authors.lastname: Crispín-Trebejo
authors.affiliation: Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.
authors.forename: María Cristina
authors.initials: MC
authors.lastname: Robles-Cuadros
authors.affiliation: Surgery Department, Hospital de Emergencias Grau, Lima, Peru.
authors.forename: Edwin
authors.initials: E
authors.lastname: Orendo-Velásquez
authors.affiliation: Escola de Medicina, Universidade Anhembi Morumbi, São Paulo, Brasil. Electronic address: f_passosandrade@hotmail.com.
authors.forename: Felipe P
authors.initials: FP
authors.lastname: Andrade
keywords: Abdominal surgery; Hernia; Internal abdominal hernia; Intestinal obstruction/sigmoid mesocolon; Radiology; Transmesenteric hernia