Laparoscopic surgery for two patients with strangulated transomental hernias

Abstract

Background: Transomental hernias are a rare type of internal hernia. We report two cases of successful cases of laparoscopic repair. One required laparotomy due to concern for intestinal viability. Case presentation: The first patient was a 67-year-old man who presented with abdominal pain and vomiting. He had no history of laparotomy or abdominal injury. Computed tomography suggested small bowel obstruction and possible intestinal strangulation. Emergent laparoscopy found approximately 200 cm of small bowel was strangulated around the greater omentum. The strangulation was released laparoscopically, but because of the color of the strangulated bowel, laparotomy was performed to evaluate viability. The involved portion of intestine was not resected. The patient experienced transient postoperative paralytic ileus and was discharged on postoperative day 14. The second patient was a 56-year-old man who presented with abdominal pain. Abdominal computed tomography revealed dilatation of the small intestine and a closed loop suggesting ileus due to intestinal strangulation. An emergency laparoscopy found a transomental hernia, and the strangulation was released laparoscopically. Recovery was uneventful, and the patient was discharged on postoperative day 6. Conclusion: Transomental hernia can be successfully treated laparoscopically. In cases where bowel viability is a concern, laparotomy should not be hesitated.

A Spontaneous Transomental Hernia: A Rare Cause of Bowel Obstruction

“…Transomental hernia treatment is the reduction of the herniated bowel segment with surgery. Surgery performed by laparotomy or laparoscopy can be used in selected patients ( 7 ). Resection and anastomosis of the bowel are necessary for an unviable segment.…”

Strangulated transomental hernia in virgin abdomen: laparoscopic surgery with a small laparotomy may be useful to assess the indeterminate viability of the bowel

“…According to the past literatures, most transomental hernias surgeries have been performed through laparotomy [ 3 ]. To the best of our knowledge, among the few reports of laparoscopic surgery, most procedures were carried out only by laparoscopic technique to release the incarceration [ 3 , 4 , 6 , 7 ]. As in this case, when it is difficult to assess the viability of the bowel, open laparotomy was chosen over laparoscopic surgery for transomental hernia because laparoscopy alone was not considered sufficient to determine the bowel viability [ 4 ].…”

“…To the best of our knowledge, among the few reports of laparoscopic surgery, most procedures were carried out only by laparoscopic technique to release the incarceration [ 3 , 4 , 6 , 7 ]. As in this case, when it is difficult to assess the viability of the bowel, open laparotomy was chosen over laparoscopic surgery for transomental hernia because laparoscopy alone was not considered sufficient to determine the bowel viability [ 4 ]. Certainly, the indication of laparoscopic surgery for the transomental hernias should be carefully considered to prevent the risk associated with inadequate observation of the involved bowel by laparoscopy.…”

Laparoscopic-assisted treatment for diospyrobezoar-induced intestinal obstruction after distal gastrectomy and cholecystectomy

“…It is difficult to try the dissolution by Coca-Cola® without a confirmed diagnosis. Although small bowel obstruction limits the working space for laparoscopic surgery and makes findings foreign bodies difficult, the laparoscopic approach to small bowel obstruction is becoming more popular (8,9). We had enough working space because we performed the laparoscopic procedure after intestinal decompression with a transnasal ileus tube, and the foreign body was easily identified.…”