A case of intestinal obstruction due to a hernia traversing the lesser sac

Abstract

A case of a hernia traversing the lesser sac with a primary defect in the greater omentum and a secondary defect in the lesser omentum is reported herein. This type of internal hernia is extremely rare and we have found only three other reported cases apart from our case. All four cases in whom this type of hernia occurred were young people. The general manifestation resembles acute intestinal obstruction and a plain radiograph shows obstruction of the upper small intestine. An erect lateral view of the abdomen often shows the anatomical location more clearly. Bowel resection was performed in two cases and all of the four reported cases recovered uneventfully.

Herniation through both Winslow’s foramen and a lesser omental defect: Report of a case

“…10 There have been no reports of the recurrence of Winslow's foraminal hernia, and postoperative mortality is less than 5% in Europe and America 11 and 0% in Japan. The present case of an internal hernia occurring due to an abnormal defect of the lesser omentum is the tenth to be documented in Japan [12][13][14][15][16][17][18][19][20] (Table 2). The incidence by sex was identical, and the majority of patients were aged between 19 and 34 years old.…”

Lesser sac hernia through the gastrocolic ligament: CT diagnosis

“…The characteristic radiological appearances of the lesser sac hernia are a distended collection of bowel loops in the upper abdomen, fluid levels in the region of the lesser sac, and signs of mechanical bowel obstruction [10,11,13]. The stomach is usually displaced anteriorly and laterally [13].…”

“…Herniation through the gastrocolic ligament or the gastrohepatic ligament is rare because the small intestine, which is the commonest content, normally locates behind the greater omentum [7]. Double omental hernia like the present case is exceedingly rare [8][9][10][11]. …”

Internal hernia traversing the lesser sac

“…The less common types are those related to defects in the transverse mesocolon, greater (gastrocolic) omentum or lesser (gastrohepatic) omentum 7 . Hernias that traverse the lesser sac necessitate two separate defects and are understandably extremely rare, with less than 10 reported cases 7–10 …”

“…Male patients aged 20–50 years are the most commonly affected 7 . The time from onset of symptoms to hospitalization ranged from 5 h to 9 days in four reported cases of lesser sac traversing hernias 8 . One patient gave a history of episodic vague abdominal pain over a 9‐year period.…”