Korean J Gastroenterol.  2022 Oct;80(4):186-189. 10.4166/kjg.2022.065.

Small Bowel Obstruction Caused by Spontaneous Transomental Hernia: A Case Report

• Ahn SR
• Kim KY
• Lee JH

• KMID: 2534467
• DOI: http://doi.org/10.4166/kjg.2022.065

Abstract

An internal hernia is a protrusion of visceral contents through a defect in the mesentery or peritoneum. Small bowel obstruction is a common clinical presentation of internal hernias, accounting for 4.1% of all intestinal obstructions. Transomental hernia is a rare type of internal hernia (1-4% of internal hernias), with non-specific symptoms, making its preoperative diagnosis difficult. It is strangulated more frequently, and the postoperative mortality rate is high (30%). Therefore, early diagnosis and management are crucial. We report a case of a 77-year-old female who presented with small bowel obstruction, and a suspected incarcerated internal hernia on abdomen-pelvis CT. A spontaneous transomental hernia was confirmed on emergency laparotomy.

Keyword

Internal hernia; Intestinal obstruction; Omentum

Figure

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  Fig. 1 Abdominal X-ray shows usual bowel gas pattern.

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  Fig. 2 Abdomen-pelvis computed tomography findings. (A) Dilated small bowel loops locate within the lesser sac. (B) A beak sign at the suspected hernia orifice locates in the left lower quadrant (arrow) and herniated small bowel loop is showing ischemic change. H, herniated small bowel; P, pancreas; S, stomach.

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  Fig. 3 Intraoperative findings. (A) Small bowel loops with ischemic changes locate in the lesser sac (white arrow). (B) Small bowel loops herniate through a defect in the greater omentum. (C) A 2 cm defect is observed in the greater omentum. G, greater omentum; P, proximal portion of herniated small bowel; T, transverse colon.

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