Transomental hernia – An enigmatic case report causing bowel obstruction in a virgin abdomen

Buainain, Latifa Al; Kaundinya, Kiran B.; Hammed, Faizal

doi:10.1016/j.ijscr.2019.11.034

Cited by 9 publications

(6 citation statements)

References 13 publications

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“…In TOH, incarceration may depend on the defect size and length of the herniated bowel loop. 4,5,8 Since our patient was elderly and without history of any surgery, trauma, or peritoneal inflammation, the TOH was most probably spontaneous, due to senile atrophy of the GO. According to a study that analyzed 188 patients with TOH by Tsuchida et al 10 In conclusion, spontaneous TOH is a rare disease that is difficult to diagnose before surgery because of its non-specific symptoms.…”

Section: Discussionmentioning

confidence: 95%

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Small Bowel Obstruction Caused by Spontaneous Transomental Hernia: A Case Report

Ahn

Kim

Lee

2022

Korean J Gastroenterol

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An internal hernia is a protrusion of visceral contents through a defect in the mesentery or peritoneum. Small bowel obstruction is a common clinical presentation of internal hernias, accounting for 4.1% of all intestinal obstructions. Transomental hernia is a rare type of internal hernia (1-4% of internal hernias), with non-specific symptoms, making its preoperative diagnosis difficult. It is strangulated more frequently, and the postoperative mortality rate is high (30%). Therefore, early diagnosis and management are crucial. We report a case of a 77-year-old female who presented with small bowel obstruction, and a suspected incarcerated internal hernia on abdomen-pelvis CT. A spontaneous transomental hernia was confirmed on emergency laparotomy.

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Section: Discussionmentioning

confidence: 95%

“…Therefore, early diagnosis and treatment are important. 4,5 Herein, we report a case of a spontaneous TOH presenting with small bowel obstruction in a patient without history of any surgery, trauma, or peritoneal inflammation.…”

Section: Introductionmentioning

confidence: 99%

Small Bowel Obstruction Caused by Spontaneous Transomental Hernia: A Case Report

Ahn

Kim

Lee

2022

Korean J Gastroenterol

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“…Postoperative recovery was uneventful, and the patient experienced relief from abdominal pain and resolution of bowel obstruction symptoms. 9,10 Internal hernias were previously considered a rare cause of small bowel obstruction, but their incidence has been increasing in the past two decades. This is partly due to increased detection but likely also due to the increased use of laparoscopic and robotic surgery for abdominopelvic procedures, which makes closure of internal defects more challenging.…”

Section: Discussionmentioning

confidence: 99%

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

Montero-Puga,

Pat-Cruz,

Arredondo

2024

Int Surg J

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Internal hernias are classified in congenital or acquired. Congenital arises from abnormalities during embryonic development, whereas acquired result from trauma, surgical procedures, or another. Gastric surgical procedures can increase susceptibility to internal hernias. A 85-year-old female, denies previous surgeries. Went to the emergency department due to vomiting, adding colicky abdominal pain. Was discharged with a diagnosis of acute gastroenteritis. Came back 12 hours after discharge due to mesogastric pain accompanied by general malaise, abdominal distention and hyporexia, reporting a lack of evacuation. She was algid, pale, abdomen globose, distended, tympanic colonic frame, peristalsis increased. An evaluation was requested from general surgery for probable appendicitis in the elderly vs. secondary ileus. Went to operation room, finding an internal hernia. Transomental herniations are rare conditions. An abnormal omental opening can be either acquired following abdominal surgery, trauma, inflammatory conditions, low body mass index (BMI) and be associated with a long mesentery, intestinal malrotation, or abnormal peritoneal attachments. Although internal hernias are extremely rare (between 1 and 4% of acute or intermittent intestinal obstructions) it is essential not to miss this diagnosis, even in patient whit no previous surgeries. Management of omental hernias are critical as the postoperative mortality rate is over 30% and even 50% if strangulation is present. The lack of current literature on this rare condition, particularly for lesser omental hernias (because can present with nonspecific signs and symptoms) makes diagnosis and management difficult.

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

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

Sawano

Kurokawa

Ozaki

et al. 2022

Journal of Surgical Case Reports

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A 66-year-old female without prior history of abdominal surgery visited the emergency department with a complain of sudden intensive lower abdominal pain. Closed loop bowel obstruction was discovered on contrast-enhanced computed tomography, leading to a laparoscopic examination of 5 h after the onset. During laparoscopy, 100 cm of distal jejunum with borderline viability was found incarcerated in a gap of the greater omentum. A 3-cm small incision was made at the umbilical trocar site to observe the bowel after it was released laparoscopically. When viewed under the shadowless lamp, the affected bowel appeared reddish, with peristalsis and a palpated mesentery artery. The surgical team determined no need for resection. The postoperative recovery went smoothly without any complications. Laparoscopic surgery for transomental hernias can be performed safely even in patients with borderline bowel viability, and observing bowel extra-peritoneally with a small incision could be helpful for laparoscopic surgery for internal hernias with borderline viability.

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Transomental hernia – An enigmatic case report causing bowel obstruction in a virgin abdomen

Cited by 9 publications

References 13 publications

Small Bowel Obstruction Caused by Spontaneous Transomental Hernia: A Case Report

Small Bowel Obstruction Caused by Spontaneous Transomental Hernia: A Case Report

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

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

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