Mesentery Of Transverse Colon Research Articles

Cadaveric and CT angiography study of vessels around the transverse colon mesentery

BackgroundLaparoscopic and robotic surgery for transverse colon cancer are difficult due to complex fusion of the foregut and midgut and variation of the vessels of the transverse colon. Although the vessels of the right colon have been investigated, middle colic artery (MCA) variation and the relationship with vessels around the transvers colon are unknown. We investigated variation of the MCA using computed tomography angiography (CTA) and cadaver specimen and the relationship between the superior mesenteric vein (SMV) and MCA using CTA. The classification of vessels around the transverse colon may lead to safer and reliable surgery.MethodsThis study included 505 consecutive patients who underwent CTA in our institution from 2014 to 2020 and 44 cadaver specimens. Vascular anatomical classifications and relationships were analyzed using CT images.ResultsThe MCA was defined as the arteries arising from the superior mesenteric artery (SMA) that flowed into the transverse colon at the distal ends. The classifications were as follows: type I, branching right and left from common trunk; type II, the right and left branches bifurcated separately from the SMA; and type III, the MCA branched from a vessel other than the SMA. Type II was subclassified into two subtypes, type IIa with one left branch and type IIb with two or more left branches from SMA. In the CTA and cadaver studies, respectively, the classifications were as follows: type I, n = 290 and n = 31; type IIa, n = 211 and n = 13; type IIb, n = 3 and n = 0; and type III, n = 1 and n = 0. We classified the relationship between the MCA and left side of the SMV into three types: type A, a common trunk runs along the left edge of the SMV (n = 173; 59.7%); type B, a right branch of the MCA runs along the left edge of the SMV (n = 116; 40.0%); and type C, the MCA runs dorsal of the SMV (n = 1; 0.3%).ConclusionsThis study revealed that The MCA branching classifications and relationship between the SMV and MCA. Preoperative CT angiography may be able to reliably identify vessel variation, which may be useful in clinical practice.

Accidental multiple magnet ingestion by an adult: a case report

Accidental multiple magnetic foreign body ingestion although common in children is rare in adults. Multiple magnetic foreign body ingestion possess a definitive risk of causing intestinal perforation, volvulus or fistulas and requires early surgical intervention even in apparently asymptomatic individuals to prevent catastrophic complications. We report a case of an 18 year old male with a history of accidental simultaneous ingestion of two semi-circular shaped magnets along with a nail. The peculiarity of the case being that despite the magnets being simultaneously ingested, one was in the stomach and the other in the jejunum adhered to each other through the transverse colon mesentery causing pressure necrosis of the adjoining wall with the patient being asymptomatic.

Gastrointestinal stromal tumor at an unusual site with an unusual presentation

Gastrointestinal tumors (GIST) are malignant and rare forms of soft tissue sarcoma arising from interstitial cells of Cajal. With most common site of origin being stomach, Jejunal GIST accounts for 0.1–3% of all GIST. Due to non specific signs and symptoms diagnosis is often delayed and patient mostly presents in advanced stage. 50 year old female presented with decreased appetite from 5 months and lump in upper abdomen from 3 months associated with dull abdominal pain from 15 days. CECT abdomen showed a large soft tissue mass in left lumbar region. Exploratory laparotomy showed a highly vascular mass of size 12x10x8 cm abutting mesentery of transverse colon lodged between middle colic artery and superior mesenteric artery. Resection of mass with a segment of jejunum was done. Histopathological examination showed spindle cell tumor with high mitotic index with CD 117+. Adjuvant chemotherapy was given and patient is currently asymptomatic after 9 months of postoperative follow up. Spectrum of clinical presentation is broad so a preoperative diagnosis is difficult. GIST primarily presenting as an abdominal lump is rare and only 25 cases have been reported so far. Surgery is the primary mode of treatment but imatinib has transformed the treatment. Newer drugs are under phase II trials and hopefully will change the course of management in near future.

Foreign Body Extraction Extravaganza! Approach to 25 Foreign Bodies, One Patient

Introduction: Specific characteristics of foreign bodies can present as challenges to successful endoscopic removal. Endoscopic removal is urgent in cases of sharp objects, esophageal obstruction, or battery ingestion. Case: A 45-year old Caucasian inmate with a history of bipolar disorder, self-injurious behavior (including self-mutilation creating enterocutaneous fistula), and ingestion of six AA batteries previously presented for repeat ingestion of multiple foreign bodies with diffuse abdominal pain, hemoptysis, and nausea. His vitals were stable with no significant lab abnormalities. Abdominal x-ray revealed 3 radio-opaque foreign bodies: An irregular circular object, a straightened paperclip, and a hexagonal/rectangular density. Cross-sectional imaging noted stable appearance straightened paperclip was interposed between stomach and transverse colon mesentery without perforation or inflammation. Neck and chest x-rays were negative for perforated viscus. Upper endoscopy was initially performed with moderate sedation, revealing multiple sharp razor blades in the stomach. The procedure was aborted to be performed with general anesthesia. Subsequent endoscopy resumed under general anesthesia. A blunt disc-shaped metallic object was removed with rat-toothed forceps and one AA battery was removed with a snare. A hood placed at the end of the endoscope for removal of sharp razorblades, however only partially opened at GE junction. A long esophageal overtube was placed. Subsequently, 21 razor blades were individually removed as an endoscopy technician held overtube in place to prevent migration and exposing GE junction/distal esophagus to sharp objects. Finally, two irregular circular objects, one of which became lodged into the overtube, were removed with both the snared lodged object and overtube taken out together from the mouth at the conclusion of the procedure. The patient tolerated the procedure well and was extubated without complication. Follow up abdominal x-ray did not reveal any remaining foreign bodies. The patient remained stable and discharged. Conclusions: Endotracheal intubation and general anesthesia should be considered for prolonged cases and safe endoscopic removal of multiple and/or sharp foreign bodies. A long esophageal overtube is preferred over hood for removal of sharp objects from the stomach. Future design improvements in endoscopic tools could aid in safer and more effective means of foreign body removal.1889_A Figure 1 No Caption available.1889_B Figure 2 No Caption available.1889_C Figure 3 No Caption available.

A Rare Cause of Acute Abdomen: Multifocal Calcifying Fibrous Tumor

Calcifying fibrous tumor (CFT) is a rare benign lesion, mostly located in soft tissues, pleura and peritoneum. Differential diagnosis and total excision of the lesions are important. This is a case of a nineteen years old boy admitted to the emergency service with colic abdominal pain, guarding and rebound tenderness. Imaging modalities revealed nothing except minimal fluid at pelvic area. After 12 hours follow up, due to increament of rebound tenderness and guarding, the patient was taken to laparotomy. At exploration, 7x5x4 cm mass between small intestine mesentery and transverse colon mesentery, three 2x1x1 cm mass at antimesenteric part of terminal ileum, multiple white-gray calcified milimetric lesions at omentum and multiple lymphadenopathies (LAP) at ileum mesentery were determined. Omentum, all described lesions and 2 LAPs were excised. Treatment of CFT is total excision of lesions. No death or no metastasis are declared but few local recurrences are reported. Follow up is important.

Recurrencia colónica tardía de adenocarcinoma endometrial

La tasa de recurrencia del carcinoma endometrial después de la cirugía más radioterapia es baja y la mayoría de los casos ocurren dentro de los primeros 3 años. La cúpula vaginal es el sitio más común de recurrencia. La recurrencia del cáncer endometrial al colon es muy rara. Se presenta el caso de una mujer de 69 años que presentaba dolor en fosa ilíaca izquierda, anorexia y pérdida de peso de 5 meses de evolución, con antecedentes de histerectomía abdominal total y ooforosalpingectomía bilateral por carcinoma endometrial estadio IA hacía 7 años. La colonoscopia reveló constricción circunferencial en el tercio medio del colon transverso, sospechosa de compresión extrínseca. La tomografía computada no reveló si la tumoración se originaba en el colon sigmoides o lo rodeaba. Durante la laparotomía, se observó enfermedad macroscópica que afectaba colon transverso y mesenterio del intestino delgado, con estenosis vascular. Se realizó la resección intestinal de las porciones afectadas y omentectomía total, sin dejar enfermedad residual macroscópica durante el procedimiento. El análisis inmunohistoquímico reveló adenocarcinoma endometrial pobremente diferenciado. La paciente se recuperó sin complicaciones y fue tratada con quimioterapia adyuvante.

Weight Loss … Whatʼs Lying Underneath … Sclerosing Mesenteritis

Sclerosing mesenteritis is a rare, benign pathological condition characterized by chronic fibrotic inflammation of the adipose tissue of the mesentery of small and large bowel. This condition with unknown etiology, lacks special and specific clinical presentation with typical signs, so easily misdiagnosed. Diagnosis can be challenging and complex, as clinical presentation ranging from asymptomatic to acute abdomen, require appropriate clinical, imaging and histopathological evaluation. A 59 years old man being a non-smoker, presented as outpatient with the history of significant weight loss of 30 Kg in last 3 months with no abdominal pain or discomfort. He had no significant past medical or surgical history with no prior history of medication intake. He underwent complete laboratory evaluation including blood picture, liver profile, thyroid and renal functions, all were normal except for ESR of 44 and stool for occult blood was positive. Esophagoscopy and colonoscopy performed showing gastritis and a polypoidal rectal mass. He then underwent CT scan revealing a rectal mass with a partly calcified soft tissue lesion involving the mesentery of small intestine. Biopsy of rectal mass was inconclusive followed by biopsy of the lymphnodes that again showed features of chronic nonspecific inflammation. Underwent exploratory laparotomy for definitive diagnosis, found to have the hard calcified nodules in the ant.abd wall, ascending colon mesentary, multiple small bowel mesentery and mesentary of transverse colon. no gross ascites, No liver, bowel or kidney involvement. The patient's postoperative course was uneventful. Pathology examination proved to be consistent with sclerosing mesenteritis with dense inflammation and fibrosis with foamy histiocytes and lymphoid aggregates. Prednisolone was started along with methotrexate by the oncologist. Clinically he started to improve and gained weight.As clinically he remained stable rather improved so repeat CT scan was not performed. It is a rare idiopathic inflammatory disorder involving predominantly small bowel mesentery. Diagnosis is a challenge to surgeons, radiologists, gastroenterologists and pathologists. Proper evaluation of the patient regarding their clinical features, imaging and histopathology is required. Overall prognosis is usually good and recurrence seems to be rare. However long-term follow-up is needed to document the results.Figure: SPOKE WHEEL appearance of mesentery.Figure: Enhancing mesentery.Figure: SPOKE WHEEL appearance of mesentery.

The Duodenum

The duodenum is the first part of the small intestine that arises from the embryologic foregut and midgut. With maturation, it lies mostly retroperitoneal and is intimately associated with nearby structures such as the pancreas, hepatoduodenal ligament, and transverse colon mesentery. It is well vascularized with a rich lymphatic network and supports digestive, absorptive, immune, and endocrine functions. The duodenum receives food bolus from the stomach and releases various hormones important for regulating motility and gastric acid secretion. In the duodenum, food content mixes with bile and pancreatic enzymes to continue digestion of and initiate absorption for fats, carbohydrates, proteins, and vitamins and minerals. The duodenum experiences substantial exposure to the external environment and therefore contains an extensive immune barrier, including mucosa-associated lymphoid tissue. Additionally, there is a significant neuroendocrine network within the duodenum and small intestine that possesses a variety of endocrine functions, including regulation of acid secretion, motility, pancreatic function, bile flow, and mucosal cell growth. These enterochromaffin cells are the source duodenal neuroendocrine tumors (carcinoid) and can be classified according to subtype or grade. The duodenum is a diverse component of the small intestine that is uniquely suited to its numerous functions. Key words: absorption, acid secretion, anatomy, digestion, duodenum, intestinal immune system, microstructure, motility, mucosa-associated lymphoid tissue, neuroendocrine

The Duodenum

The duodenum is the first part of the small intestine that arises from the embryologic foregut and midgut. With maturation, it lies mostly retroperitoneal and is intimately associated with nearby structures such as the pancreas, hepatoduodenal ligament, and transverse colon mesentery. It is well vascularized with a rich lymphatic network and supports digestive, absorptive, immune, and endocrine functions. The duodenum receives food bolus from the stomach and releases various hormones important for regulating motility and gastric acid secretion. In the duodenum, food content mixes with bile and pancreatic enzymes to continue digestion of and initiate absorption for fats, carbohydrates, proteins, and vitamins and minerals. The duodenum experiences substantial exposure to the external environment and therefore contains an extensive immune barrier, including mucosa-associated lymphoid tissue. Additionally, there is a significant neuroendocrine network within the duodenum and small intestine that possesses a variety of endocrine functions, including regulation of acid secretion, motility, pancreatic function, bile flow, and mucosal cell growth. These enterochromaffin cells are the source duodenal neuroendocrine tumors (carcinoid) and can be classified according to subtype or grade. The duodenum is a diverse component of the small intestine that is uniquely suited to its numerous functions. Key words: absorption, acid secretion, anatomy, digestion, duodenum, intestinal immune system, microstructure, motility, mucosa-associated lymphoid tissue, neuroendocrine

The key points of prevention for special surgical complications after radical operation of gastric cancer

Incidence of gastric cancer is high in China and standard radical operation is currently the main treatment for gastric cancer. Postoperative complications, especially some special complications, can directly affect the prognosis of patients, even result in the increase of mortality. But the incidences of these special complications are low, so these complications are often misdiagnosed and delayed in treatment owing to insufficient recognition of medical staff. These special complications include (1) Peterson hernia: It is an abdominal hernia developed in the space between Roux loop and transverse colon mesentery after Roux-Y reconstruction of digestive tract. Peterson hernia is rare and can quickly result in gangrenous ileus. Because of low incidence and without specific clinical symptoms, this hernia does not attract enough attention in clinical practice, so the outcome will be very serious. Once the diagnosis is made, an emergent operation must be performed immediately. Peterson space should be closed routinely in order to avoid the development of hernia. (2) Lymphatic leakage: It is also called chyle leakage. Cisterna chylus is formed by gradual concentration of extensive lymphatic net to diaphragm angle within abdominal cavity. Lymphadenectomy during operation may easily damage lymphatic net and result in leakage. The use of ultrasonic scalpel can decrease the risk of lymphatic leakage in certain degree. If lymphatic leakage is found during operation, transfixion should be performed in time. Treatment includes total parenteral nutrition, maintenance of internal environment, supplement of protein, and observation by clamp as an attempt. (3)Duodenal stump leakage: It is one of serious complications affecting the recovery and leading to death after subtotal gastrectomy. Correct management of duodenal stump during operation is one of key points of the prevention of duodenal stump leakage. Routine purse embedding of duodenal stump is recommend during operation. The key treatment of this complication is to promt diagnosis and effective hemostasis.(4) Blood supply disorder of Roux-Y intestinal loop: Main preventive principle of this complication is to pay attention to the blood supply of vascular arch in intestinal edge. (5) Anastomotic obstruction by big purse of jejunal stump: When Roux-en-Y anastomosis is performed after distal radical operation for gastric cancer, anvil is placed in the remnant stomach and anastomat from distal jejunal stump is placed to make gastrojejunal anastomosis, and the stump is closed with big purse embedding. The embedding jejunal stump may enter gastric cavity leading to internal hernia and anastomotic obstruction. We suggest that application of interruptable and interlocking suture and fixation of stump on the gastric wall can avoid the development of this complication.

Role of Hydro-Dissection Facilitated Monopolar Cauterization Dissection Technique on Separation of the Greater Omentum From the Superior Layer of the Transverse Mesocolon During D2 Radical Gastrectomy

Adequate separation of the omentum from the transverse colon mesentery, during D2 radical gastrectomy, is usually difficult and often time-consuming due to anatomic variations. The aim of this prospective study was to compare the electrocautery dissection technique with hydrodissection-facilitated electrocauterization for the separation of the greater omentum from the superior layer of the transverse mesocolon in gastric cancer patients undergoing D2 radical gastrectomy. The time taken to separate the greater omentum from the superior layer of the transverse mesocolon, and the number and extension of iatrogenically-created mesocolonic defects were assessed. Forty patients were prospectively randomized into 2 groups. Separation of the greater omentum from the superior layer of the transverse mesocolon was achieved in Group I (n = 20) patients by the monopolar cauterization dissection technique whereas in Group II (n = 20) patients by the hydrodissection-facilitated monopolar cauterization. No significant difference was found between the 2 groups in terms of age, gender, body mass index (BMI), type of surgical technique, or the number of resected lymph nodes (P > 0.05). The difference between the 2 dissection techniques was not statistically significant when compared according to the number of iatrogenic mesocolonic defects, extension of the defects, or the time period required for the separation of greater omentum from the superior layer of the transverse mesocolon (P > 0.05). The overall survival was not significantly different between the 2 dissection techniques (P > 0.05). Hydrodissection is a safe technique that can be applied as an adjunct to electrocauterization to facilitate the dissection in the correct plane during resection of the mesogastrium.

網嚢内嵌入腸管が大網を穿破し脱出した横行結腸間膜裂孔ヘルニアの1例

症例は67歳，女性．腹部手術歴なし．下腹部痛，嘔吐を主訴に救急外来を受診．腹部CTにて大網をヘルニア内容とする臍ヘルニアと小腸イレウスの診断となった．イレウスチューブを挿入し保存的に経過観察したが，腹痛が増強したため緊急手術となった．臍ヘルニアを開放し，腹腔内に到達した．横行結腸間膜に約3cmの裂孔を認め，Treitz靱帯から約180cmの位置から小腸が約100cm嵌頓，絞扼していた．網嚢内に嵌入した小腸は大網を穿破して，横行結腸の腹側を通り尾側に翻っていた．絞扼された小腸を切除縫合，横行結腸間膜裂孔閉鎖，臍ヘルニア修復後手術を終了した．自験例は臍ヘルニアの併発により，大網が牽引されることで固定され，網嚢内に嵌入した小腸が拡張して大網を穿破し，網嚢から脱出したと考えられた．

PTU-008 Is cranial to caudal approach a feasible technique for complete mesocolic excision (cme) in laparoscopic transverse colectomy?

<h3>Introduction</h3> Laparoscopic transverse colectomy (LTC) is one of the most challenging techniques because the region of its mesentery and lymph node (LN) dissection is controversial. In addition, anatomical anomalies are often observed in the root of middle colic artery (MCA), which is surrounded by critical vessels such as superior mesenteric vein (SMV), splenic vein (SPV) and inferior mesenteric vein (IMV). We believe that cranial to caudal approach is one of the answers against how to overcome the hurdle of CME and LN dissection in LTC because it’s relatively easy to discern the border of transverse colon mesentery from pancreas. Another is to clarify the dominantly feeding vessel and establish the interest region of lymphandectomy by using CT colonography and angiography preoperatively. <h3>Method</h3> First, we open the bursa omentalis widely through the gastrocolic ligament, and subsequently mobilise and take down the hepatic and splenic flexure. The anterior lobe of transverse mesocolon is then dissected at the inferior border of the pancreas with the so-called cranial to caudal approach. Right gastroepiploic vein (RGEV) is a landmark to reach SMV. Exposing pancreatic head and second potion of duodenum and blunt dissection are also important to take down hepatic flexure of transverse colon and detach mesentery of transverse colon. In the process, we transect one or two accessory right colonic vein (ARCV). With skeletonizing SMV to proximal side, merging of SMV, SPV and IMV are uncovered. We think it’s critical to harvest the lymph nodes completely in the region enclosed by SMV, SPV and IMV where there should be generally the root of MCA. CT angiography is a robust support to comprehensively recognise the vessel anatomical anomalies and dissected region of colon mesentery. Continuously, it’s possible to dissect the root of ileocolic and right colic vessels with skeletonizing ventral surface of SMA and SMV in this approach. <h3>Results</h3> We herein present our practical laparoscopic transverse colectomy with LN dissection in video as attatched to demonstrate our concept and strategy in this field. <h3>Conclusion</h3> We think that cranial to caudal approach is a feasible technique for complete mesocolic excision in laparoscopic transverse colectomy. <h3>Disclosure of interest</h3> None Declared.

Severe Vascular Complications Of Acute Pancreatitis.

Acute pancreatitis (AP) develops as a result of the imbalance of the mechanisms inhibiting the activity of enzymes in the pancreatic cells, which causes their autoactivation in the pancreas. The incidence of AP ranges from 10 up to 100 cases per 100,000 population per year in different parts of the world. The overall mortality rate for acute pancreatitis is 10-15%. The mortality rate in patients diagnosed with the severe form of acute pancreatitis is up to 30-40%. The study included 10 patients treated due to acute pancreatitis in two surgical departments run by one of the authors (S.G.) in the years 2004-2014, who developed a serious complication in the form of haemorrhage into the inflammatory tumour/pancreatic cyst or an adjacent organ. Haemorrhage was diagnosed based on the clinical picture, most often a sudden drop in blood pressure, peritonitis symptoms and imaging findings--abdominal ultrasound and abdominal computed tomography. Therapeutic methods included conservative treatment, endovascular embolisation and, in the absence of efficacy of the above mentioned methods, surgical treatment. Patients age and gender, the etiological factor, comorbidities, Atlanta Classification, treatment outcomes and mortality rate were assessed. Alcohol was the most common etiological factor in the investigated AP cases. The patients received conservative treatment, interventional radiology treatment (endovascular embolisation) or surgical treatment. In the study group, 6 patients required surgical treatment, 3 patients received invasive radiology treatment, and conservative treatment was used in one patient. The mortality rate in the study group was 30%. Haemorrhages into the inflammatory cisterns or adjacent organs (stomach, transverse colon mesentery) secondary to AP are the most severe complications, which are difficult to manage. The successful use of interventional radiology methods to inhibit and prevent the recurrence of bleeding in some of the patients is a significant milestone.

嵌頓小腸が食道裂孔を経て縦隔内に嵌入した横行結腸間膜裂孔ヘルニアの1例

嵌頓小腸が食道裂孔を経て縦隔内に嵌入した横行結腸間膜裂孔ヘルニアの1例

Primary neuroendocrine tumor of the colon mesentery

Primary neuroendocrine tumor of the mesentery is very rare. More than 90% of gastrointestinal neuroendocrine tumors are located in the appendix, small intestine and rectum. We present a case of very rare primary neuroendocrine tumor of the mesentery showing malignant character though large size. The patient visited Yeungnam University Medical Center presented with palpable abdominal mass which had known occasionally. At laparotomy, a huge mass was found to be arising from transverse colon mesentery and mass was invasion to transverse colon and anterior antrum of the stomach. The mass was measured as 20.5×15.0 cm sized that demonstrated a malignant character. At 19 months of follow-up, the patient was recurrence free. Keywords: Neuroendocrine tumor, Mesentery, Neoplasms

Locally advanced pseudopapillary neoplasm of the pancreas in a male patient: a case report.

Solid pseudopapillary tumor of the pancreas is a rare neoplasm, predominantly observed in young women and with greatest incidence in the second and third decade. Although large at the time of diagnosis, it has clinically good behavior. The occurrence of infiltrating varieties of solid pseudopapillary tumors is very rare. We report the case of a 48-year-old man with a giant mass in the pancreas, incidentally discovered during an abdominal ultrasonography. The mass was later investigated using multidetector computed tomography and magnetic resonance imaging. The lobulated lesion had cystic-necrotic appearances which lead the radiologists to suggest the possibility of either a gastrointestinal stromal tumor or a pancreatic cancer. The patient was operated. Operative signs showed that the tumor invaded the splenic hilum and mesentery of transverse colon. En-block resection of pancreas, spleen and transverse colon was performed as the mass was thought to be a locally advanced pancreas tumor. Pathological diagnosis reported a solid pseudopapillary tumor. Although solid pseudopapillary tumor is considered a rare tumor, with a very rare rate of locally infiltrating variety, and rarely presents in males, it must be kept in mind while making the differential diagnosis of cystic pancreatic lesions to begin appropriate clinical management.

Image fusion for hybrid repair of dislocated superior mesenteric branch of a branched endovascular aortic graft

Recent advances in imaging technology allow the projection of volumetric imaging data from the preacquired computed tomography angiography over live fluoroscopy during interventions. This "fusion" technology is currently underused, although its application carries distinct advantages. We introduce a case in which fusion technology was used for the placement of two thoracic and one branched abdominal aortic endograft and to treat late dislocation of its side branch using a hybrid technique.

横行結腸間膜裂孔ヘルニアによるS状結腸絞扼性イレウスの1例

横行結腸間膜裂孔ヘルニアによるS状結腸絞扼性イレウスの1例

横行結腸間膜裂孔ヘルニアの1例

症例は86歳，女性．開腹手術歴無し．吐気・腹痛が出現したため近医受診し腹部単純レントゲン写真でイレウスと診断，精査加療目的で当院紹介となった．腹部単純CTでは腹水を伴った小腸拡張を認めたが明らかな閉塞機転は指摘できず，腹部膨隆はあるが軟らかく反跳痛は認めなかったため消化器内科へ入院，イレウス管を挿入し間欠持続吸引にて保存的治療を試みた．しかし入院後イレウス管による改善は乏しく，第3病日にCTを施行したが小腸拡張像は変化無く腹水が増加し保存的治療での改善は難しいと考え緊急手術を行った．開腹所見ではTreitz靱帯右側の横行結腸間膜に約3cmの裂孔を認め，ここから網嚢内へTreitz靱帯から約80cmの空腸が約40cm嵌入していた．小腸の腸管壊死は認めなかったため，整復後は裂孔部を縫合閉鎖し手術終了した．術後経過は良好だった．術後CTを見直すとヘルニア門は確認できたため，CTにて術前診断し得る症例と考えられた．