LAUSR

A 76-year-old female, with a history of arterial hypertension, was operated 20 years prior for a complicated ulcer. She had an antrectomy with Roux-en-Y gastrojejunostomy. She presented to the emergency with sudden onset abdominal pain and vomiting. On examination, she was agitated, afebrile and haemodynamically stable. She had periumbilical abdominal tenderness. On blood tests, she had a white cell count of 13 500 cells/mm, 12.4 Hb g/dl and 38 CRP mg/l. Electrolytes, renal and liver function were normal. Computed tomography (CT) scan revealed an increase in the mesenteric density and the wall thickness of the jejunal and proximal ileal bowel (Fig. 1). Laparotomy was then performed. Findings included 2 m of jejunum and proximal ileum herniating through a 5 cm mesenteric defect, located in the proximal jejunal mesentery. (Fig. 2). The hernia was reduced. Ischemic bowel regained good vitality. The mesenteric defect was then closed (Fig. 3). The patient recovered uneventfully. We reported successful surgical treatment for an acquired transmesenteric hernia. The surgical intervention was rapid allowing to avoid intestinal necrosis. Acquired transmesenteric hernias result from incomplete closure of surgically created mesenteric defects. Clinical presentation is not specific. Patients appear with vomiting, abdominal bloating, acute abdominal pain, and shock. Preoperative diagnosis of transmesenteric herniae is difficult. CT scan is used to aid diagnosis. Delayed intervention can lead to bowel ischemia, necrosis and death.