Purpose or Case Report: Internal hernias are a rare cause of chronic abdominal pain and bowel obstruction in pediatric patients. Furthermore, congenital trans-mesenteric hernias constitute only 5–10% of internal hernias. Internal paraduodenal hernias are more common in adults secondary to postoperative mesentery defects. However, transmesenteric hernias in children are caused from a congenital defect in small bowel mesentery near the ileoceclal region or ligament of trietz.

The subject of the case report is a 17 year old male who presented to primary care for several weeks of chronic abdominal pain and recurrent billious emesis. Initial abdominal radiographs demonstrated no evidence of obstruction. The patient presented to radiology for CT evaluation which demonstrated herniated loops of mid small bowel in the left hemiabdomen through a mesenteric defect. Patient was taken to the operating room for an elective exploratory laporotomy which demonstrated herniated loops of jejunum at the mesenteric defect near the ligament of trietz. The herniated loops of jejunum were anchored to duodenum and the mesenteric defect was closed. Patient tolerated the surgery without any complications and reports resolution of symptoms.

Trans-mesenteric hernias are difficult to diagnose due to lack of specific physical symptoms or laboratory findings to confirm the suspicion. Therefore, imaging findings play a vital role in diagnosis. CT imaging is useful to evaluate for mesenteric defects, obstruction and ischemia. Internal hernias with congenital mesenteric defects should be included in the differential for chronic abdominal and small bowel obstructions.
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