A 10 years old male presented with acute onset progressive abdominal pain and bilious vomiting for 2 days, abdominal distension and absolute constipation for last 1 day. Pain started at periumbilical region and then became diffuse. At first pain was intermittent and colicky, later became dull aching and constant. Patient had associated 10-12 episodes of projectile bilious vomiting for last 2 days. There was no past H/O any surgery or chronic illness. On general survey patient was dehydrated and had tachycardia and tachypnoea. On abdominal examination there was abdominal distension, less abdominal movement with respiration, visible peristalsis at epigastric and umbilical region. Hernial orifices were normal. Guarding, generalised tenderness and rebound tenderness was present, hyperperistaltic sound was present. Investigations revealed leucocytosis, straight X-ray abdomen showed multiple air fluid level in central part of abdomen. Patient was resuscitated with IV fluids and exploratory laparotomy was performed. On exploration strangulated jejunum(of 15cm length) was seen 50cm distal to DJ flexure which was seen herniated through a round mesenteric defect (approximated 5cm diameter) adjacent to the strangulated segment. Portion of the gut was gangrenous and non viable.Resection of the affected part of jejunum with end to end jejunojejunal anastomosis done in interrupted single layer extramucosal technique with polyglycolic 3-0.Mesenteric defect was closed. Post - operative recovery was uneventful.
Internal hernia;Transmesenteric hernia;Strangulation;Congenital mesenteric defect