2019 Volume 39 Issue 1 Pages 089-093
A 41-year-old man with a history of having undergone laparoscopic total colectomy for familial adenomatous polyposis presented to our hospital with the chief complaints of abdominal pain and nausea. Computed tomography showed dilatation of the small intestine and the superior mesenteric artery (SMA) got over the stomach through the lesser curvature. Thus, the SMA was located on the ventral aspect of the stomach. The intestinal obstruction was immediately relieved by insertion of a long nasointestinal tube. A review of the patient’s history revealed that he had previously presented with multiple episodes of obstruction, presumably caused by the same mechanism. Therefore, we decided to perform elective surgery. Intraoperatively, a 5-cm defect of the lesser omentum was found, and the small intestine was found herniating through this defect. This segment of the small intestine was not dilated. The intestine was pulled back within the abdomen, and the defect of the lesser omentum was sutured. The postoperative course of the patient was unremarkable, and at the 15-month postoperative follow-up, the patient was found to have made favorable progress. Lesser omental hernia is rare, but suturing of the defect may represent effective therapy. Further studies and more cases are needed to optimize the therapeutic strategy.
