Congenital internal hernia is a rare cause of bowel obstruction in adults and often presents with complications. A high index of suspicion, occasionally aided by appropriate radiological imaging, should lead to early surgical intervention and thus reduce morbidity and mortality. We describe a case of a 27-year-old woman who presented with upper abdominal pain and nonspecific abdominal signs. Computed tomography showed features of bowel ischemia which prompted surgical intervention. On exploration, she was found to have a large mesenteric defect with herniating ileum and ascending colon. A segment of gangrenous small bowel was resected. The mesenteric defect was repaired and the bowel tacked down to prevent volvulus. The Patient made an uneventful recovery
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