Transverse mesocolic internal hernia: a case of acute small bowel obstruction

Internal hernias are a rare but significant cause of acute small bowel obstruction, often presenting diagnostic challenges due to their non-specific clinical manifestations. This case report describes a 74-year-old female with acute small bowel obstruction caused by a transverse mesocolic internal hernia, an uncommon subtype. The patient presented with abdominal pain, bloating, and vomiting, with a history of hypertension, asthma, and diabetes mellitus, but no previous abdominal surgeries. Abdominal tomography revealed signs consistent with small bowel obstruction, and emergency surgery was performed. Intraoperatively, a distal jejunal loop was found trapped in an abnormal mesenteric opening near the splenic flexure and descending colon. The hernia was reduced, and a small perforation in the bowel was repaired. The patient had an uneventful recovery and was discharged on the 10th postoperative day. This case highlights the importance of early diagnosis and surgical intervention in managing internal hernias to prevent complications. Laparotomy remains a viable option in elderly patients with significant comorbidities, although laparoscopic surgery may be considered in selected cases.