Acute abdomen by congenital internal hernia in a preschool child. Case report

Abstract

Introduction. The internal hernia occurs rarely, especially in children, with picture of acute abdominal pain and intestinal obstruction. Incarcerated and strangulated bowel
may progress to ischemia, necrosis and perforation, with mortality up to 50%. Preoperative diagnosis is a challenging, despite computed tomography imaging, and the index of
suspicion is very low.

Presentation of the case. 5 year old boy from Cuernavaca, Morelos, Mexico. Previously healthy, he presented with severe abdominal pain and vomiting lasting for 24 hours.
Neither fever nor diarrhea were present. Laboratory tests, X-rays and ultrasound studies suggested acute appendicitis. Intestinal ischemia was found in a part of small bowel herniated through a congenital mesenteric defect. It evolved to necrosis after the first surgery. The child required an intestinal resection and ileostomy in the second procedure and  whole anastomosis in the third. He recovered well and was discharged in a week.

Discussion. There are few reports of congenital transmesenteric internal hernia in children. Catastrophic outcomes are published due to the uncommon presentation,
delayed diagnosis and treatment and occasional occurrence. We found 23 reports, five in Mexico. We need higher index of suspicion to diagnose, especially in children with nonspecific symptoms of acute abdomen.