A Case of a Lesser Omental Hernia after Reoperation (Transverse Colostomy) following Abdominoperineal Resection

Abstract

An 89-year-old woman presented to our hospital with a chief complaint of gastric discomfort for the past 2 or 3 months. She had a history of laparoscopic abdominoperineal resection and laparoscopic transverse colostomy. Computed tomography showed a dilated intestinal canal and collecting vessels on the ventral side of the lesser curvature, and emergency surgery was performed after gastric tube decompression based on the diagnosis of an internal hernia. There was an abnormal, 5-cm-long hiatus at the lesser curvature, and the small intestine was fitted from the dorsal side of the hiatus to the ventral side. No intestinal necrosis was observed, and the abnormal hiatus was sutured closed. The patient had a good postoperative course and was discharged home on the seventh postoperative day, and no recurrence has been observed eight months after the surgery. In this case, the small intestine passed through the open omental bursa due to partial loss of the mesentery of the transverse colon caused by a previous operation, and it was thought to have entered into the hiatus that was caused by some unknown mechanism. Although a lesser omental hernia is one of the rarest internal hernias, its characteristic imaging findings may lead to a preoperative diagnosis.