A 32-year-old woman with abdominal pain and vomiting was admitted to our institution 12 days after parturition. Physical examination revealed distention and tenderness of the whole abdomen. Computed tomography demonstrated bowel dilatation, suggesting intestinal obstruction (IO) (Figure A). A transnasal intestinal tube was placed, but no improvement was noted (Figure B). Thus, surgery was suggested. Intraoperatively, the 50-cm jejunum, at a meter distal from the Treitz’ ligament was edematous and congested because of incarceration via the transmesocolon (Figure C). A 25-mm-wide defect in the right side of the transmesocolon was observed at the hernia orifice, suggesting a transmesocolic internal hernia (TIH) (Figure D). Simple closure of the hernia orifice without bowel resection resolved her symptoms gradually.
Internal hernia (IH) accounts for 0.2%–0.9% of all recorded causes of IO at autopsy. If left untreated, IH has an overall mortality of >50%. TIH constitutes 8% of all IH, followed by paraduodenal hernia (53%). The majority occur in childhood due to congenital TIH, whereas acquired TIH is less common, occurring mainly in elderly men. As this first description of TIH in a perinatal woman shows, perinatal women can develop acquired TIH due to increased intra-abdominal pressure during parturition, leading to fatal IO.
Footnotes
Conflicts of Interest: The authors disclose no conflicts.
Funding: The authors report no funding.
Ethical Statement: The corresponding author, on behalf of all authors, jointly and severally, certifies that their institution has approved the protocol for any investigation involving humans or animals and that all experimentation was conducted in conformity with ethical and humane principles of research.
Reporting Gudelines: Helsinki Declaration.