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.
Keywords
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References
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Article Info
Publication History
Published online: January 16, 2021
Accepted:
January 12,
2021
Received:
January 5,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2021 Elsevier Inc. All rights reserved.
