Abstract
A 91-year-old woman with inappetence, abdominal pain, and vomiting was diagnosed by her family doctor with bowel obstruction and referred to our department. Upon physical examinations, slight abdominal tenderness was noted and the abdomen was found to be generally distended but soft. Computed tomography revealed an obstruction of the transverse colon near the splenic flexure, extension of the proximal colon and ileum, and incarceration of the distal transverse colon through the omental bursa. We diagnosed a trans-omental hernia caused by transverse colon incarceration through the omental bursa, and performed an operation. A 3 cm hiatus was found in the greater omentum 20 cm from the hepatic flexure of the distal transverse colon. This was determined to be the hernia gate. The distal transverse colon was incarcerated through the back of the lesser omentum into the omental bursa. We performed surgery, incising the hiatus widely to recover the incarcerated transverse colon from the hernia gate and open the cavity of the omental bursa. A trans-omental hernia is rare and typically involves incarceration of the small intestine. We report an extremely rare case (only 3 previously reported cases in Japan) of a trans-omental hernia caused by transverse colon incarceration though the omental bursa that was diagnosed preoperatively using computed tomography.
