Abstract
A 78-year-old woman who had no past of abdominal surgery or injury came to our hospital because of pain and vomiting. On admission her abdomen was distended and tender. Abdominal X-ray films revealed dilated loops of small intestine in the upper abdomen, and a CT scan showed an intestinal shadow in the omental bursa. An ileus long tube was inserted, but the intestinal shadow did not resolve and we operated suspecting internal hernia. At laparotomy defect in the lesser omentum was found to be a hernia orifice, and 30cm of small intestine were incarcerated. The small intestine was not necrotic, so the lesser omentum was partially resected and the small intestine was reduced. The postoperative course was good, and the patient was discharged after 4 weeks.
Internal hernia is rare in ileus, and we have reported an even rarer case of lesser omental hernia along with a review of the literature. There are many unkown aspects of the predisposing causes of lesser omental hernia, but treatment is the same as in any other type of ileus. When caring for ileus patients, the possibility of internal hernia should be kept in mind. We should be alert to the characterisitc X-ray and findings.
