Lesser omental hernia after total colectomy: report of a case

Abstract

Lesser omental hernia is a rare type of hernia that can cause intestinal obstruction. To our knowledge, there are only 16 documented cases of lesser omental hernia, including the present case. The subject of this case report was a 42-year-old man with a history of total colectomy for colon perforation caused by Crohn's disease 15 years earlier, who presented with epigastralgia and vomiting. Abdominal computed tomography (CT) revealed a distended bowel loop ventral to the stomach and convergence of mesenteric vessels at the lesser curvature of the stomach. Based on a diagnosis of intestinal obstruction caused by a lesser omental hernia, he underwent emergency surgery, which revealed a 150-cm jejunal segment herniating through a 5-cm defect in the lesser omentum from the retrogastric space. We reduced the herniated loop and closed the hernial orifice successfully. We describe the characteristic CT findings, which allowed us to make the preoperative diagnosis, and speculate how the past total colectomy, in which the gastrocolic ligament was isolated and the transverse colon was resected, probably caused by this hernia. This case serves to demonstrate that lesser omental hernia could be a postoperative complication of total colectomy.

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

“…Additionally, we performed a literature search using the keyword "lesser omental hernia" and obtained a total of 11 reports in PubMed. The findings of these cases, including ours, are summarized in Table 1 [3][4][5][6][7][8][9][10][11][12][13]. The mean age of the patients was 43.5 years, ranging from 14 to 73 years.…”

“…1 Abdominal CT images. a There is distention of the small intestine in the distal, ventral part of the distorted stomach, accumulated liquid around the liver; and reduced enhancement in the intestinal mucosa; (b) The small intestine is prolapsed through the defected lesser omentum, as denoted by the arrows; (c) These is dislocation of the blood vessels of the small intestine and distorted stomach, as indicated by arrow causative factors indicated that defects in the lesser omentum were caused by congenital factors in six cases [3-6, 9, 10], while 3 cases were caused by previous abdominal surgeries [7,8], and the remaining cases were caused by unidentified factors. Our patient underwent a total colectomy approximately 2 years before the onset of the lesser omental hernia.…”

“…However, it is a severe clinical condition and can result in intestinal obstruction and other life-threatening complications [1,2]. To date, very few cases of lesser omental hernia have been reported across the world [3][4][5][6][7][8][9][10][11][12][13]. It is challenging for emergency surgeons to make a timely and accurate diagnosis of lesser omental hernia, as the symptoms are unspecific and overlap with those of other gastrointestinal diseases.…”

Internal herniation through lesser omentum hiatus and gastrocolic ligament with malrotation: a case report

“…Konishi et al . reported 16 cases of a small sac hernia and CT showed abnormal anatomic locations, including small bowel loops in the lesser sac or ventral to the stomach in 86% (6/7) of the patients, and convergence of the mesenteric vessels at the superior lesser curvature of the stomach in 43% (3/7) [ 4 ]. Another report described mesenteric vessels stretching anterior to the inferior vena cava and posterior to the portal vein [ 5 ].…”

“…Another report described mesenteric vessels stretching anterior to the inferior vena cava and posterior to the portal vein [ 5 ]. However, there are no previous reports of a confirmed preoperative diagnosis [ 4 ]. Diagnostic abdominal puncture can support strangulated intestinal obstruction diagnosis as long as bloody fluid is detected.…”