Abstract
We experienced a case of transepiploic hernia. A 47-year-old man was seen at the hospital because of epigastric pain and vomiting. An abdominal X-ray showed an enlarged intestinal gas shadow and the patient was admitted for bowel obstruction. He was observed conservatively with a short tube inserted, but no remission in clinical findings was noted. Due to an air-fluid level appearing on the abdominal X-ray, a long tube was inserted. As a loop formation of the small intestine was detected on an ileus tube enterogram, a laparotomy was carried out with a diagnosis of adhesive ileus. The jejunum was herniated through abnormal omental hiatus to the omental bursa and adhered to the lesser omentum. About 10cm of the jejunum was resected and the hiatus was sutured.
Transomental hernia is a rare disease and only 77 cases have been reported in Japan. The disease presents difficulty in preoperatively diagnosis because it is so uncommon and lacks specific findings in clinical and X-ray examinations. But it may be possible to make preoperative diagnosis in cases presenting omental bursa hernia like this case by confirming the air-fluid level locating in the gastric lesser curvature side on abdominal simple X-ray examination and the presence of the intestine in the omental bursa on abdominal CT.
