Spontaneous Transomental Hernia

Abstract

A transomental hernia through the greater or lesser omentum is rare, accounting for approximately 4% of internal hernias. Transomental hernias are generally reported in patients aged over fifty. In such instances, acquired transomental hernias are usual, are commonly iatrogenic, and result from surgical interventions or from trauma or peritoneal inflammation. In rare cases, such as the one described in this study, internal hernias through the greater or lesser omentum occur spontaneously as the result of senile atrophy without history of surgery, trauma, or inflammation. A transomental hernia has a high postoperative mortality rate of 30%, and emergency diagnosis and treatment are critical. We report a case of a spontaneous transomental hernia of the small intestine causing intestinal obstruction. An internal hernia with strangulation of the small bowel in the lesser sac was suspected from the image study. After an emergency laparotomy, a transomental hernia was diagnosed.

Spontaneous Transomental Hernia Combined with Incarcerated Inguinal Hernia: A Case Report

“…Thus, TOH is a rare entity among various causes of SBO. In children with TOH, the omental defect is usually a congenital anomaly caused by embryonic developmental failure [2,3]. In contrast, most of the omental defects in adult TOH cases are acquired because of a previous intra-abdominal event [2][3][4][5][6].…”

“…TOH is known to be more prone to develop strangulation of the herniated bowel than other types of internal hernia [2,4,7,9,10]. Therefore, for the treatment of TOH, emergency surgery must be attempted as soon as possible.…”

“…In children with TOH, the omental defect is usually a congenital anomaly caused by embryonic developmental failure [2,3]. In contrast, most of the omental defects in adult TOH cases are acquired because of a previous intra-abdominal event [2][3][4][5][6]. In a few adult TOH cases, however, the defect might be created because of senile atrophy and/or weakness of the omentum without a predisposing history, as in our patient, and these cases are referred to as "spontaneous" TOH [2][3][4][5].…”

“…The incidence of TOH is rare, accounting for only 1-4% of total internal hernia cases [1], and most of the omental defects are acquired because of a previous intraabdominal event, such as abdominal surgery, trauma, or intraabdominal inflammation [2][3][4][5][6]. Here, we report a rare case of spontaneous TOH that presented 42 hour after successful manual repositioning of an incarcerated inguinal hernia.…”

“…Transomental hernia (TOH) is a rare type of internal hernia, in which a loop of the small bowel herniates through an abnormal defect in the omentum, resulting in strangulation of the herniated bowel, with significant morbidity and mortality [1][2][3][4][5][6]. The incidence of TOH is rare, accounting for only 1-4% of total internal hernia cases [1], and most of the omental defects are acquired because of a previous intraabdominal event, such as abdominal surgery, trauma, or intraabdominal inflammation [2][3][4][5][6].…”