A Case of Strangulated Obstruction Caused by Transomental Hernia: Useful to Use Laparoscopy for Diagnosis

With Reference to the Literature on Previously Reported Cases

Abstract

Transomental hernia often develops into strangulated ileus, but is difficult to diagnose preoperatively due to a lack of specific symptoms. We report a patient with strangulated ileus due to transomental hernia, diagnosed via laparoscopy. A26-year-old man admitted for epigastralgia was referred the next day to the department of surgery because of progressive abdominal pain and muscle defense. Abdominal CT showed dislocation of the small intestine into the omental bursa. We diagnosed strangulated ileus due to an internal hernia and conducted emergency surgery. When the laparoscopic view showed a necrotic intestine, we immediately conducted a laparotomy. The ileum had herniated through an abnormal omental hiatus to the omental bursa and was strangulated by minor omental hiatus. About 60 cm of the ileum was resected and the hiatus was closed by direct suture. In this case, laparotomy was followed by a diagnosis of necrotic intestine, suggesting the utility of laparoscopy in diagnosis or repositioning when internal hernia is suspected.