Hérnia interna transmesocólica congênita: diagnostico transoperatório

E apresentado o caso clinico-cirurgico de paciente com hernia interna transmesocolica, localizada a esquerda dos vasos colicos medios. Os exames pre-operatorios apontavam para o diagnostico de obstrucao intestinal alta, secundaria a pseudocisto pancreatico. A lise das aderencias entre as alcas foi trabalhosa e o tratamento completou-se com a reducao do conteudo e com a sintese do orificio herniario do mesocolon transverso. Na revisao literaria, verifica-se que, na maioria dos casos de hernia interna relatados, o diagnostico e confirmado no ato operatorio. Este caso ilustra a dificuldade no estabelecimento do diagnostico pre- operatorio de hernia interna transmesocolica, assim como o diagnostico diferencial com pseudocisto pancreatico, alem do tratamento cirurgico inerente a este caso especifico. A surgical clinical case of a patient, with transmesocolon internal hernia, located at left of the medium colic vasa is reported. Medical examination done before surgery pointed toward a diagnosis of high intestinal obstruction, secondary to a pancreatic pseudocyst. It was difficult to perform the lysis of the adherences between the folds. The treatment came to completion by reduction of the contents and with the synthesis of the transverse mesocolon hernia orifice. It becomes clear from the literature that, in most of the reports on internal hernias, the diagnosis is confirmed only through the surgical procedure. This case illustrates the difficulty in building a diagnosis of a transmesocolon internal hernia before surgery as well as in the differential diagnosis of a pancreatic pseudocyst.