A Case of Pediatric Internal Hernia Heralded by Constipation

Meckel's diverticulum (MD) is the most common gastrointestinal congenital anomaly of the small intestine. A small subset of patients with MD develops a mesodiverticular band (MDB), creating a snare-like opening and the potential for internal hernias (IHs). IHs are a known possible cause of small bowel obstructions and are most common in adults post bariatric surgery. Herein, we present an atypical case of pediatric internal hernia caused by an MDB. A six-year-old male child with chronic constipation presented with one week of abdominal pain and one day of non-bloody, non-bilious emesis, decreased appetite, and normal non-bloody bowel movements. The patient appeared uncomfortable with mild abdominal right upper quadrant tenderness. Laboratory results were remarkable for mild leukocytosis and hyperkalemia. Computed tomography was concerning for IH. General surgery performed a diagnostic laparotomy, revealing an IH caused by an MDB. The MDB was released, and the patient had an uneventful recovery. Pediatric IHs are very rare. Surgery represents the primary management of symptomatic MDBs, as it allows for the hernia to be released before complications occur, such as bowel necrosis or gangrene. This case highlights the importance of considering IH caused by MDB in pediatric patients presenting with constipation.