Congenital Middle Mesocolic Hernia: A Rare Cause of Neonatal
Congenital mesocolic hernia is an extremely rare, but serious cause of intestinal obstruction in children. Given the rarity of this condition, delays in diagnosis and management can have catastrophic consequences. Congenital mesocolic hernias are usually caused by an abnormal rotation of primitive mid-gut and are divided into left and right congenital mesocolic hernias. We report and discuss the clinical and radiological features and management of a neonate with an extremely rare variant, congenital middle mesocolic hernia along with a literature review of this rare condition.

A preterm male neonate of 34 weeks gestation having antenatal scans showing dilated loops of bowel and an enlarged stomach, prompting early investigations soon after birth. He was stable at birth and his clinical examination was unremarkable, apart from bilious nasogastric aspirates. Abdominal plain film showed dilated bowel loops in the upper abdomen with paucity of gas in the rest of the abdomen (Fig.1). An upper gastrointestinal (UGI) contrast study (Fig.1), demonstrated free flow of contrast into a markedly distended duodenum with normal positioned duodeno-jejunal (DJ) flexure to the left side of the midline. There was a significant hold up of contrast at the DJ flexure, with a small amount of contrast trickling into a normal calibre jejunum. These findings were suggestive of a partial obstruction of the duodenum at the DJ flexure....