Internal hernia (IH) is a rare intestinal obstruction. One of the many forms of IH, the transmesenteric hernia, which is caused by a mesenteric defect, is a very rare clinical entity. Herein, we present a case of transmesenteric hernia with multiple episodes of postprandial abdominal pain, vomiting and unexplained ileus. A delay in diagnosis of IH may result in high expectation of morbidity and mortality. Abdominal computerized tomography (CT) is the most appropriate early diagnostic tool for this rare IH variant. Emergency physicians (EPs) should always include IH in the differential diagnosis of unexplained mechanical ileus.