Transmesenteric Herniation through Congenital Mesenteric Defect leading to Bowel Gangrene

A 5-year-old male presented with severe abdominal pain and non-bilious vomiting for 2 days along with abdominal distension for the last 24 hours. The patient was seen by a general practitioner who prescribed antipyretic and analgesics following which his pain settled for 10–12 hours. However, mother noticed abdominal distension on the next day. He did not pass stool for 12 hours. Despite abdominal distension the pain did not recur. On arrival in ER, the patient was lethargic and dehydrated with a respiratory rate of 42/min, pulse of 130 beats /min, blood pressure of 70/40mmHg and temperature of 100o F. Abdomen was grossly distended but not tender. On digital rectal examination rectum was empty. Nasogastric tube instantly drained 250 ml of bilious fluid. X-ray abdomen showed few dilated bowel gas shadows.