Congenital Treves’ field transmesenteric hernia in 7-month-old infant: A case report

Abstract

Introduction: Congenital Treves’ field hernia is the herniation of a visceral segment through a defect in the terminal ileal mesentery, poses a high risk of strangulation and bowel gangrene. Its preoperative diagnosis is challenging due to its rarity, nonspecific presentation, and often inconclusive imaging. Case presentation: A previously healthy 7-month-old female infant presented with an 18-h history of intense diffuse abdominal pain, nausea, and bilious vomiting. On examination, she appeared ill and dehydrated, with tachycardia and tachypnea. Her abdomen was grossly distended, tense, and tender, with no visible scars or hernias. Blood tests, including a complete blood count, urea, and electrolytes, were normal except for an elevated white blood cell count. Abdominal X-rays and ultrasound revealed features consistent with distal small bowel obstruction, with no evidence of intussusception. Following resuscitation, an emergency laparotomy was performed for suspected acute abdomen due to distal small bowel obstruction. Intraoperatively, the jejunum and proximal ileum were dilated, and a portion of the ilium was found herniated through a 6 × 4 cm mesenteric defect. After reduction, approximately 25 cm of necrotic small bowel was resected, followed by an end-to-end anastomosis. The postoperative recovery was smooth, and she was discharged on day seven with no signs of short bowel syndrome on follow-up. Conclusion: Congenital Treves’ field transmesenteric hernia is a rare cause of intestinal obstruction in children that should be considered in cases of mechanical small bowel obstruction.

Keywords

• Treves' field hernia
• Acute bowel obstruction
• Case report
• Children