• Irini D Batsis, Ololade Okito, James A Meltzer, and Sandra J Cunningham.
• Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
• J Emerg Med. 2015 Sep 1; 49 (3): 277-80.

BackgroundAn internal hernia is a rare cause of intestinal obstruction, which can occur at any age. Children most often develop an internal hernia due to a congenital defect in the mesentery. While some patients are asymptomatic, others present to medical attention with vague abdominal symptoms, an acute abdomen, or in shock.Case ReportWe report a case of a 5-day-old previously healthy baby who presented to our pediatric emergency department with bilious vomiting, grossly bloody stool, and abdominal distention. During an exploratory laparotomy, the patient was diagnosed with an internal hernia caused by a congenital mesenteric defect. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although internal hernia is an infrequent cause of intestinal obstruction in a newborn and requires emergent operative repair, it may be mistaken for other more common causes, such as necrotizing entercolitis, which are often managed medically. This case report aims to highlight some of the difficulties in diagnosis and key features that may assist the clinician in identifying these patients.Copyright © 2015 Elsevier Inc. All rights reserved.

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