2013 Volume 33 Issue 5 Pages 871-874
A 79-year-old woman was admitted with a 2-day history of vomiting and epigastric pain. The patient was fully conscious and the vital signs were stable. She complained of spontaneous abdominal pain and a mild swelling was observed in the upper abdomen; however, there was no tenderness or other evidence of peritoneal irritation. MDCT-MPR images revealed the extended, small intestine on the ventral side of the transverse colon, a positive beak sign and mesenteric convergence. Based on the findings, we made the diagnosis of transomental hernia. CT revealed no ischemic changes, and since the abdominal findings also tended to subside, we started conservative medical treatment with ileus tube insertion. Decompression of the upper small intestine was achieved successfully, however, the incarcerated hiatal hernia was not released. We conducted laparotomy on day 5. The jejunum was found to be invaginated in the abnormal omental hiatus, however, the intestinal segment was not ischemic. The diagnosis of transomental hernia must be kept in mind in patients with no history of laparotomy presenting with ileus. MDCT-MPR may be useful for the diagnosis.
