An extremely rare case of lesser omental hernia in an elderly female patient following total colectomy

Abstract

Background: An intro-abdominal hernia through the lesser omentum is a rare but severe condition that can cause intestinal obstruction and other life-threating complications. Until now, only a handful of cases have been reported worldwide. The diagnosis of lesser omental hernia remains challenging for emergency surgeons because of the unspecific symptoms. Therefore, there is a need for a better understanding of the characteristics of this condition.Case presentation: In this report, we described the case of a 73-year-old female patient who was diagnosed with a lesser omental hernia caused by previous total colectomy. The patient underwent emergency surgery, and the intraoperative findings revealed a 200-cm segment of the small intestine was herniated through a defected lesser omentum (approximately 3 × 4 cm) from the lesser retrogastric curvature of the stomach. Besides, we summarize the specific abdominal computed tomography (CT) findings of lesser omental hernia by reviewing the literature. Conclusion:The lesser omental hernia is extremely rare but can cause serious complications. The cause of lesser omental hernia can be congenital or acquired. Careful examination of the small omentum before the closure of the abdomen is expected to reduce the occurrence of these abdominal surgery-associated complications. The specific features of abdominal CT in cases of lesser omental hernia, which are summarized in this article, can help other clinicians to obtain accurate diagnoses of lesser omentum hernia in the future.

Internal hernia a preoperative diagnostic challenge in virgin abdomen: case report

“…Lack of current literature on this rare condition, particularly for lesser omental hernias, which can present with nonspecific signs and symptoms, makes diagnosis and management difficult. [5][6][7] Ping et al report a case seen in a 76-year-old Malay gentleman with no known medical illnesses presented with acute symptoms of vomiting and periumbilical pain radiating to the epigastric region for two days. 8 The abdominal pain was cramping, and the pain score was graded as 10.…”

Laparoscopically treated bowel obstruction secondary to a lesser omental hernia resulting from a previous laparoscopic total colectomy for ulcerative colitis: A report of two cases

“…Previous reports have revealed that the small bowel, inserted into a lesser omental hernia, is commonly extremely long. 4,5 This suggests that a lesser omental hernia may be difficult to conservatively restore subsequent to a laparoscopic subtotal or total colectomy. Thus, we believe that treatment should involve surgically returning the bowel to the original position thereof and repairing the hernial hiatus.…”

Lesser sac hernia through the gastrocolic ligament 20 years post subtotal colectomy

“…Lesser sac hernia risk factors include common intestinal mesentery, long small bowel mesentery and an enlarged foramen of Winslow, which all commonly predispose to foramen of Winslow lesser sac hernias 7 . Other risk factors postulated include underlying congenital malformations, extreme weight loss, inflammatory conditions and previous small or large bowel surgery as seen in this case 2,3,5,8 . In most cases, herniation of trans‐omental origin is usually of congenital origin with post‐operative herniation very rare.…”

“…Omental bursa hernias are rare, accounting for less than 1% of internal hernias 2,3 . Currently, fewer than 30 transomental hernias have been recorded in literature, with several of these cases having recorded herniation specifically through the gastrocolic ligament 1,2,4–6 …”

“…However, contrast CT remains the standard in defining trans‐omental bowel obstructions 10 . Features of omental bursa hernias usually include small bowel loops in the lesser sac (Figs 1,2), convergence of mesenteric vessels towards the superior lesser curvature of the stomach, anterolateral displacement of the stomach, displacement of the transverse colon and omental vessels circumferentially surrounding the hernial orifice 2,10 …”