A Case of an Incarcerated Transomental Hernia Diagnosed with Abdominal CT

Abstract

A 41-year-old male with sudden onset of epigastric pain was brought to our hospital by ambulance. He had not previously undergone any surgery. On physical examination, the abdomen was tender with muscular guarding in the umbilical region. A computed tomography (CT) scan of the abdomen revealed the presence of ascites, dilated small bowel and convergence of the mesentery suggestive of a strangulated internal abdominal hernia and an emergency operation was performed. Following laparotomy, a loop of the small intestine, approximately 1m in length, had herniated through a hole in the great omentum with resultant necrosis, thus confirming the diagnosis of a transomental hernia. The incarcerated bowel was in the ileum 3m10cm distal to the ligament of Treitz. The hole was opened and the necrosed portion of the small intestine was resected. The postoperative course was uneventful and the patient was discharged from the hospital on day 10. Internal hernias are an uncommon disease. The transomental hernia is particularly rare and it was difficult to make a correct diagnosis preoperatively. Recently some authors have reported that abdominal CT has been useful to make preoperative diagnosis. We report on a case of transomental hernia diagnosed as a incarcerated internal hernia by abdominal CT and demonstrated by surgery.