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More than just gastritis: An unusual presentation of strangulated transmesenteric hernia in a pediatric patient

Published:January 16, 2021DOI:https://doi.org/10.1016/j.ajem.2021.01.030

      Abstract

      Internal hernias are a rare occurrence, reported in only 0.2–0.9% of the general population, and predominantly occur in adult patients as postsurgical complications. However, internal hernias can occur in pediatric patients, typically due to herniation of bowel through congenital mesenteric defects, and are associated with high rates of strangulation or volvulus (up to 30–40%) in this population. These can be especially difficult to detect due to nonspecific symptoms and rarity, but carry a steep mortality rate of 45% if treated and virtually 100% if missed.
      We present a case report that describes a 3 year old patient who presented to the emergency department with less than 12 h of nonbloody, nonbilious emesis and associated abdominal pain with preserved ability to tolerate oral intake. She ultimately went on to have ultrasound and then CT imaging that revealed a high grade bowel obstruction due to an internal hernia from a mesenteric defect for which she required emergent resection of 119 cm of necrotic bowel.
      Ultimately this case illustrates a fairly benign presentation of a rare etiology of pediatric vomiting and abdominal pain that if left undetected could prove fatal, and is therefore essential for the emergency clinician to consider on the differential for vomiting and nonspecific abdominal pain in the pediatric patient.

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