Abstract
A 61-year-old woman was admitted to our hospital with epigastric pain. She had no history of abdominal surgery. Multidetector-row computed tomography (MDCT) showed a hernial orifice and engorged mesenteric vessels. A diagnosis of small intestinal obstruction due to transomental hernia was made. However there was no evidence of strangulation. Hence she underwent preserved medical treatment. After admission, her symptoms worsened. A CT scan obtained 8 hours after admission showed ascites and dilated small intestinal loops. Moreover, multiplanar reformation (MPR) clearly showed a hernial orifice. Blood gas analysis showed that her base excess had decreased to -6.6mEq/L. A diagnosis of strangulated obstruction by transomental hernia was made, and an emergency operation was performed. The necrosed portion of the small intestine, with a length of about 50cm, was resected. The patient was discharged 14 days after the operation. MDCT examination with MPR is useful for the diagnosis of transomental hernia. The possibility of transomental hernia should be considered when treating patients with an obstruction who have no history of laparotomy.
