Lesser sac herniation through the greater omentum and gastro-pancreatic ligament: Report of a case

Abstract

We report herein the case of a woman who developed a lesser sac hernia which was especially unusual in that the small bowel prolapsed through a defect in the greater omentum and was thereafter strangulated by a hole in the gastro-pancreatic ligament. The gastro-pancreatic ligament has never before been documented as causing an internal hernia. In our patient, a plain abdominal X-ray demonstrated as soft-tissue mass displacing the stomach to the left while abdominal computed tomography and ultrasonography showed a sac-like encapsulation of the small bowel loops between the liver and stomach. Careful evaluation of these radiographic findings allowed for the preoperative diagnosis of a lesser sac hernia to be made.

Clinical spectrum of internal hernia: A surgical emergency

“…1,3,9,17,[19][20][21][22] However, most of these reports document individual cases, studies of a limited group, and reviews of a special type of internal hernia. These hernias are often diffi cult to diagnose preoperatively, but their rapid progression to bowel ischemia presents a life-threatening emergency.…”

“…Many types of CIH have been reported, including paraduodenal, transmesenteric, pericecal, transmesosigmoid, supra-or perivesical, Winslow's foramen, omental hernia, and rarely, hernia through the broad ligament, the mesoappendix, or the mesentery of a Meckel's diverticulum. 1,3,9,17,[19][20][21][22] In contrast, acquired internal hernia (AIH) arises from a prior surgically created entrapment such as a Roux-en-Y anastomosis, infl ammation or infectious process, and trauma. 1,18 We conducted this retrospective study to establish the related indicators of bowel ischemia in patients who underwent surgery for an internal hernia in our institution during a 10-year period.…”

Small intestinal perforations due to acquired internal herniation

“…Unfortunately, IHs have a rapid progression to bowel ischemia and/or bowel perforation which is a life-threatening emergency. To date, most of these reports about IHs are case reports or studies with a limited number of patients, probably because of the low incidence of 0.2-0.9% [4][5][6]. Despite the limited number of cases, this report represents one of the largest series about spontaneous perforation due to acquired intestinal internal herniations.…”

Strangulated Foramen of Winslow Hernia

“…Stewart [4] classified these hernias into four types, namely, hernias through (1) the greater omentum; (2) the lesser omentum; (3) the foramen of Winslow, and (4) the transverse mesocolon. Apart from transomental hernias from which only 57 cases have been described until 1995 [5], hernias through the foramen of Winslow are distinct rarities; with our 2 patients the num ber of cases published in the world literature since the original description by Blandin in 1823 [1] is brought up to a total of 164 [1][2][3]. 120 DigSurg 1997:14:119-122…”