An unusual case of transverse mesocolic internal hernia with abnormality of both hands and high arched feet

• A case of internal abdominal herniation through a defect in transverse mesocolon with congenital abnormality of hands and feets.
• Reduction along with derotation of gut with closure of the rent and fixation of the caecum to lateral peritoneum done.
• Due to the risk of strangulation of the hernial contents, even small internal hernias are dangerous.
• Herniation through transverse mesocolon is very rare and preoperative diagnosis of mesenteric defect is difficult.
• Surgical decision-making is on the basis of clinical findings of intestinal strangulation or ischemia.

IntroductionAn internal abdominal herniation is the protrusion of a viscus through a normal or abnormal mesenteric or peritoneal aperture. It is a rare cause of small bowel obstruction with a reported incidence of 0.2–0.9%. It can either be acquired through a trauma or surgical procedure or can be related to congenital peritoneal defects. Herniation through transverse mesocolon is very rare.Presentation of caseA case of acute intestinal obstruction due to internal herniation through a congenital rent in transverse mesocolon with rotation of gut approximately 180° around axis of the band. Patient also had bilateral hypoplastic thenar muscles with rudimentary 1st metacarpals and high arched feet. Reduction along with derotation of gut, with closure of the rent in transverse mesocolon and fixation of the caecum to lateral peritoneum was performed.DiscussionThe preoperative diagnosis of mesenteric defect is difficult because of wide range of acute abdominal symptoms, and there are no specific radiographic findings. CT is the most important diagnostic tool is, with 77% accuracy in such cases. Due to the risk of strangulation of the hernial contents, even small internal hernias are dangerous and may be lethal.ConclusionInternal hernia should be suspected in patients with signs and symptoms of intestinal obstruction, particularly in the absence of inflammatory intestinal diseases, external hernia or previous laparotomy. Surgical decision-making is on the basis of clinical findings of intestinal strangulation or ischemia, and emergency laparotomy should be performed without preoperative diagnosis of such a rare disease.