HighlightsThere are no cardinal symptoms for internal hernia.Internal hernia must be kept as a differential diagnosis in the case of intestinal obstruction in both operated and non-operated abdomen.Early diagnosis both clinically and radiologically may prevent undesirable complications.Both patient status and surgeon's experience are essential to form the best surgical decision.Fine handling of bowel, assessment of viability, closure of defects and inspecting for other potential ones, and argumenting stoma formation are the main principles of surgery.