A Case of Strangulated Bowel Obstruction Caused by the Greater Omentum Without a History of Abdominal Surgery

Abstract

A 79-year-old man presented at a local hospital with the chief complaints of postprandial epigastric pain and vomiting. He had no history of open abdominal surgery. He was referred to our hospital for the treatment of suspected bowel obstruction. Upon arrival, the patient perceived referred pain on pressure in the epigastric region, but symptoms of peritoneal irritation were not apparent. Blood test results indicated an inflammatory response with elevated lactic acid. Abdominal CT findings revealed poor contrast in the small intestinal wall, proximal small intestinal enlargement, and ascites. We suspected strangulated bowel obstruction and performed emergency open abdominal surgery, which revealed slightly bloody ascites with funicular adhesion of the greater omentum and mesentery. The small intestine was intussuscepted into this site; it was also strangulated and necrotic for a 60-cm long stretch; therefore, we performed a partial resection of the small intestine. The patient progressed well postoperatively and was discharged on hospital day 9. It is often challenging to confirm a preoperative diagnosis of strangulated bowel obstruction in the absence of an open surgery history. Our patient’s condition was caused by an internal hernia of the greater omentum that had become funicular. When bowel obstruction occurs in patients without an open surgery history, the possibility of the condition being caused by a greater omentum funicular object that is unlikely to cause abdominal symptoms should be taken into consideration when determining the patient’s eligibility for surgery.