Clinical characteristics and surgical management of congenital mesenteric defects in children: a 10-year retrospective case series

Congenital mesenteric defects (CMDs) leading to internal hernias are a rare but serious cause of intestinal obstruction in children. This study aims to analyze the clinical features, diagnostic methods, and treatment outcomes of pediatric patients diagnosed with CMDs and internal hernias over a 10-year period in a single institution. A retrospective analysis was conducted on pediatric patients (aged 0–14 years) diagnosed with congenital mesenteric defects between January 2014 and December 2023. Patient demographics, clinical presentations, diagnostic imaging details, surgical findings, and postoperative outcomes were reviewed. Fifteen patients (8 males, 7 females) with a median age of 2.4 years (range: 11 days to 4 years) were included. Common symptoms included abdominal pain, vomiting, and distension. One neonate presented with bloody stools and was preoperatively suspected of having an intussusception by ultrasound. Due to the urgency of the clinical presentations and clear surgical indications from basic imaging, none of the patients required computed tomography (CT). Diagnosis relied on basic imaging combined with acute clinical signs. All patients underwent emergency laparotomy. The mesenteric defects were exclusively located in the small bowel mesentery. Three cases presented with severe ischemic necrosis requiring segmental bowel resection and primary anastomosis without stoma creation. After bowel reduction or resection, all mesenteric defects were primarily closed to prevent recurrence. One patient developed recurrent obstruction one month postoperatively, requiring open adhesiolysis and anastomotic resection due to an adhesive band stricture. Over a follow-up period of 6 months to 1.5 years, all patients had a favorable recovery with no recurrence of internal hernias. Preoperative diagnosis of CMDs remains challenging with basic imaging alone, and clinical manifestations can mimic other acute conditions such as intussusception. However, strict adherence to surgical indications based on clinical symptoms is crucial. Timely exploratory laparotomy with bowel reduction, resection if necessary, and primary closure of the defect were associated with favorable outcomes in this cohort.