A rare case of small bowel obstruction secondary to mesenteric ring accompanying an umbilical hernia and intestinal leiomyoma

Small bowel obstruction is a surgical emergency that can be caused by many pathological processes even though the leading cause of such an obstruction is an adhesion/adhesions that have occurred following a previous surgery. The second most common cause is an incarcerated hernia. We present an interesting medical case involving a 72-year-old male patient who had a history of compensated cirrhosis, diabetes mellitus, and hypertension. He presented to the emergency room with a chief complaint of persistent vomiting, constipation, and an unreducible bulge in his anterior abdominal region, all of which had been troubling him for the past three days. The patient had an umbilical hernia, and an intraabdominal solid mass was palpated. During surgical intervention, a mesenteric band in a ring-shaped fashion entrapping the small bowel was discovered and determined to be the main cause of the obstruction. Moreover, a 7.5 cm solid mass located 20 cm distal to this obstruction was enveloping the bowel. Following the excision of the mesenteric band and the mass, side-to-side anastomosis of the intestine was performed. The solid mass was later diagnosed as an intestinal leiomyoma, which is a rare cause of small bowel obstruction. This case presents a rare occurrence due to its three possible and distinct causes of obstruction in the same patient.