Revised: December 23, 2013
Accepted: January 13, 2014
Published online: February 28, 2014
Transomental hernias are among the rarest type of all internal hernias which overall account for less than 6% of small bowel obstructions. Most transomental hernias occurring in adults are either iatrogenic or post-traumatic. More rarely, a spontaneous herniation of small bowel loops may result from senile atrophy of the omentum. We report a case of an 86-year-old male who presented with signs and symptoms of small bowel obstruction but had no past surgical or traumatic abdominal history. At contrast-enhanced multi-detector row computed tomography (CT), a cluster of fluid-filled dilated small bowel loops could be appreciated in the left flank, with associated signs of bowel wall ischemia. Swirling of the mesenteric vessels could also be appreciated and CT findings were prospectively considered consistent with a strangulated small bowel volvulus. At laparotomy, no derotation had to be performed but up to 100 cm of gangrenous small bowel loops had to be resected because of a transomental hernia through a small defect in the left part of the greater omentum. Retrospective reading of CT images was performed and findings suggestive of transomental herniation could then be appreciated.
Core tip: Transomental hernias are among the rarest type (1%) of all internal hernias, often being either iatrogenic or post-traumatic. More rarely, a spontaneous herniation may occur. We report a case of an 86-year-old male with a small bowel obstruction and no past surgical or traumatic abdominal history. Contrast-enhanced multi-detector row computed tomography showed findings consistent with a strangulated small bowel volvulus. At laparotomy, however, no derotation had to be performed but up to 100 cm of gangrenous small bowel loops had to be resected because of a strangulated transomental hernia which was prospectively overlooked but could then be retrospectively appreciated.