Epigastric Hernia With Intestinal Obstruction: An Unusual Complication of a Transmesenteric Hernia

Arch Surg. 1985;120(12):1398. doi:10.1001/archsurg.1985.01390360058014.
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To the Editor.—Herein, we describe a previously unreported association of transmesenteric and epigastric herniation.

Report of a Case.—An 84-year-old man with a 15-year history of a reducible epigastric hernia was admitted with abdominal pain, vomiting, and a tender, irreducible 15-cm epigastric mass with hyperactive bowel sounds. The abdominal roentgenogram showed dilated small bowel with a central density (Fig 1). After fluid rehydration, exploration was performed through a midline incision. On entering the peritoneal cavity, the incarcerated and infarcted small bowel was found within a second sac composed of a portion of the gastrocolic omentum (Fig 2). On further exploration, a defect in the transverse mesocolon was identified. Through this defect, the proximal jejunum had herniated into the lesser sac and then, by pushing the gastrocolic omentum ventrally, the bowel had become incarcerated in the epigastric defect. Resection of the compromised bowel with anastomosis was performed, and the gastrocolic


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