Abstract
A 59-year-old man with no history of abdominal surgery was referred to our hospital with a chief complaint of sudden upper abdominal pain. The initial examination showed evidence of peritoneal irritation, while contrast-enhanced abdominal computed tomography (CT) showed dilation of the small intestine without enhancement on the abdominal side of the gastric lesser curvature. Furthermore, a part of the intestine formed a closed loop. An emergency laparotomy was performed under a diagnosis of strangulated ileus caused by an internal hernia. At the time of surgery, a small amount of bloody ascites, as well as two dark-colored loop formations of the small intestine, was found on the ventral side of the lesser curvature. The gastrocolic ligament could not be observed due to aplasia of the major omentum and dysraphism of the major omentum and transverse colon. The bursa omentalis was extensively open. Furthermore, the ileum was seen passing to the dorsal side of the stomach through the bursa omentalis and herniated to the ventral side through an abnormal minor omental hiatus that measured 2 cm in diameter. It was strangulated and necrotic over a length of 40 cm. A partial ileectomy was performed, and the omental hiatus was closed by suturing. No other abnormal intraperitoneal findings were noted. A transomental hernia through an abnormal minor omental hiatus associated with congenital omental aplasia is extremely rare. The details of this case along with a review of relevant past reports are presented.
