Transmesenteric hernia causing small bowel obstruction following lumbar microdiscectomy

SummaryA 54-year-old male patient underwent an L3–4 and L4–5 microdiscectomy. Two days after this operation, he suffered from acute abdominal pain accompanied by nausea and vomiting. A plain upright abdominal radiograph demonstrated multiple dilated small bowel loops with air-fluid levels. Abdominal computed tomography demonstrated diffuse dilatation of the small bowel loops with collapsed colon lumen. Laparoscopic laparotomy was performed after 4 days of conservative therapy without improvement. A 2–3 cm transmesenteric hernia, an uncommon type of internal hernia, and a short segment of entrapped jejunum were observed 40 cm from the ileocecal junction. The entrapped jejunum was viable and removed from the mesenteric defect without resection, and the defect was repaired; the patient recovered after laparoscopic repair. Small bowel obstruction caused by a congenital defect in the intestinal mesentery following microscopic discectomy has never been reported.