Résumé

Introduction: Transmesenteric internal hernias are rare causes of acute intestinal obstruction in children, but they carry a high risk of strangulation, bowel necrosis, and perforation. Their preoperative diagnosis remains challenging because of nonspecific clinical manifestations, particularly in resource-limited settings where access to computed tomography is restricted. We report a case of strangulated congenital transmesenteric internal hernia complicated by ileal perforation in a child managed at the Regional Hospital Center of Ziniaré, Burkina Faso. Clinical case: An 11-year-old boy was admitted for diffuse abdominal pain, food-stained vomiting, and cessation of stool and gas passage evolving over five days in a febrile context. Physical examination revealed marked abdominal distension with generalized guarding suggestive of generalized acute peritonitis. Laboratory investigations showed inflammatory leukocytosis. Abdominal radiography demonstrated small-bowel air-fluid levels. As computed tomography was not available on an emergency basis, an exploratory laparotomy was performed. It revealed a congenital transmesenteric internal hernia complicated by ileal necrosis with perforation. Surgical treatment consisted of resection of 20 cm of ileum with end-to-end ileo-ileal anastomosis and closure of the mesenteric defect. Postoperative outcome was favorable despite a superficial surgical site infection managed medically. Discussion: Congenital internal hernias remain exceptional in pediatric surgery. Their polymorphic clinical presentation frequently results in delayed diagnosis, promoting mesenteric ischemia and severe gastrointestinal complications. Abdominal CT scan is considered the gold standard diagnostic imaging modality; however, its availability remains limited in several African countries. In such settings, diagnosis is often made intraoperatively, and management relies mainly on clinical assessment and emergency surgery. Conclusion: Transmesenteric internal hernia should be considered in any child presenting with acute intestinal obstruction without prior surgical history. Early diagnosis and prompt surgical management are essential to reduce morbidity and mortality related to intestinal ischemic complications.

Mot-clés :

Transmesenteric Internal Hernia, Acute Intestinal Obstruction, Child, Ileal Perforation,Peritonitis, Emergency Surgery, Case Report