Strangulated transomental hernia: CT findings

Delabrousse, Éric; Couvreur, Marjolein; Saguet, O; Heyd, Bruno; Brunelle, Serge; Kastler, B.

doi:10.1007/s002610000135

Cited by 35 publications

(22 citation statements)

References 5 publications

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“…Computed tomography has been proposed as a diagnostic modality for the preoperative diagnosis of internal hernias. [15][16][17][18][19][20][21] Blachar et al report CT scan sensitivity of 63%, and specificity of 76% in diagnosing transmesenteric hernias. 17 In this study, 16% of CT scans (n= 4/25) were suspicious for internal hernias, while 88% displayed signs of small bowel obstruction.…”

Section: Discussionmentioning

confidence: 96%

“…However, the CT findings considered to be the predictors of these internal hernias include engorgement of the mesenteric vessels, crowding and stretching of the mesenteric vessels, the whirl sign indicative of small bowel volvulus, right and left displacement of the descending colon, dilatation of the small bowel, presence of a transition zone, and presence of small bowel obstruction. 15,[18][19][20] A delay in surgery, the definitive treatment, leads to the development of gangrenous bowel in a large portion of patients. [10][11][12] Newsome has reported the presence of gangrenous bowel at exploration in 64% of cases (n=9/14).…”

Section: Discussionmentioning

confidence: 99%

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Internal Hernias: Clinical Findings, Management, and Outcomes in 49 Nonbariatric Cases

Ghiassi

Nguyen

Divino

et al. 2007

Journal of Gastrointestinal Surgery

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Internal hernia, the protrusion of a viscus through a peritoneal or mesenteric aperture, is a rare cause of small bowel obstruction. We report the clinical presentation, surgical management, and outcomes of one of the largest series of nonbariatric internal hernias. Ten-year retrospective review of patients at our institution yielded 49 cases of internal hernias. Majority of patients presented with symptoms of acute (75%) or intermittent (22%) small bowel obstruction. While 16% of CT scans were suspicious for internal hernia, in no cases the preoperative diagnosis of internal hernia was made. The most frequent internal hernias were transmesenteric (57.0%) and 34 hernias (69%) were caused by previous surgery. All internal hernias were reduced and the defects were repaired. Compromised bowel was present in 22 cases and 11 patients underwent small bowel resection. The mean postoperative hospitalization was 10.9 days. The overall mortality rate from our series is 2%, and the morbidity rate is 12%. Transmesenteric hernias, as complications of previous surgeries, are the most prevalent internal hernias. Preoperative diagnosis of internal hernia is extremely difficult because of the nonspecific clinical presentation. However, if discovered promptly, internal hernias can be repaired with acceptable morbidity and mortality.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Internal Hernias: Clinical Findings, Management, and Outcomes in 49 Nonbariatric Cases

Ghiassi

Nguyen

Divino

et al. 2007

Journal of Gastrointestinal Surgery

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“…Recently, several studies have reported the usefulness of CT, especially multi-detector row CT, for the preoperative diagnosis of TOH [2,9,[12][13][14]. In addition to CT signs of small bowel strangulation, (1) a cluster of dilated small bowel loops in the right paracolic gutter (2) medial and posterior displacement of the ascending colon and cecum by dilated loops and (3) absence of omental fat between the dilated loops and anterior abdominal wall, are suggested as characteristic CT findings of TOH [12,13].…”

Section: Discussionmentioning

confidence: 99%

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

Ohtsuka¹,

Takahara²

2017

J Gastrointest Dig Syst

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An 85-year-old woman was admitted to our hospital because of appetite loss and vomiting. She had no previous history of abdominal surgery, trauma, or intra-abdominal inflammation. Following the diagnosis of a small bowel obstruction due to an incarcerated left inguinal hernia, manual hernia repositioning was attempted, and proceeded smoothly. However, 42 hour after the procedure, she suddenly developed abdominal pain without recurrence of the incarcerated inguinal hernia. Abdominal computed tomography revealed signs of small bowel strangulation; therefore, emergency surgery was performed 48 hour after admission. On laparotomy, a defect was found in the greater omentum, and a part of the ileum was incarcerated by the defect. The operative diagnosis was spontaneous transomental hernia. Incision of the greater omentum was performed, and no ischemic changes were observed in the ileum; therefore, bowel resection was not performed, and the left inguinal hernia orifice was repaired. The postoperative course was uneventful. The transomental hernia in our case might have been induced because of the incarcerated inguinal hernia. For patients plagued with persistent small bowel obstruction after successful manual repositioning of an incarcerated inguinal hernia, concurrent internal hernia should be considered as a possible cause of the persistent small bowel obstruction.

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“…Transomental (greater or lesser) are rarer still accounting for less than 1% of all internal hernias and are usually a complication of previous surgical procedures. [2][3][4] Small bowel obstruction secondary to an internal hernia is a surgical emergency. Whilst abdominal radiographs and ultrasonography may be of some diagnostic use, CT scanning remains the gold standard.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Small bowel obstruction secondary to an internal hernia is a surgical emergency. Whilst abdominal radiographs and ultrasonography may be of some diagnostic use, CT scanning remains the gold standard.…”

mentioning

confidence: 99%

’The ins and outs of abdominal pain’: a case report of a transomental internal hernia

Choong

Carney

Beaconsfield

et al. 2010

annals

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A 46-year-old man was admitted via the emergency department with sudden onset, left-sided, sharp, abdominal pain that had awoken him from sleep. Two days previously, he had a similar episode of abdominal pain that resolved upon bowel opening. He had no other symptoms and had an unremarkable past medical history. On examination, he was distressed and in pain, but had a soft, non-distended abdomen. There was mild tenderness in the left iliac fossa on deep palpation, but nothing else of note. The bowel sounds were normal. Besides a minor leucocytosis, all preliminary investigations, including arterial blood gases, were reported normal. He remained haemodynamically stable throughout. However, his pain was significantly out of proportion to the clinical findings and the results of initial investigations. An unenhanced computed tomography (CT) scan of the abdomen was performed (Fig. 1). DiscussionFigure 1 is a composite image of a series of unenhanced CT sections in a craniocaudal direction. They demonstrate a distend loop of small bowel in a 'C' shape lying under the left anterior abdominal wall (image 5). The mesenteric vessels leading to this loop can be seen to be converging. There is loss of sharpness of these vessels with haziness of the fatty tissue surrounding them (images 1-4). The convergence of the vessels infers the presence of a defect through which this loop has herniated creating a 'closed loop' obstruction and the haziness is indicative of vascular compromise.Investigative laparoscopy revealed, blood-stained fluid with multiple distended loops of small bowel. At exploratory laparotomy (Fig. 2), a congested, but viable, ileal loop was found, herniating through the greater omentum. The herniation was released and the omental defect and abdomen closed. The patient was discharged 2 days later.Internal hernias have an autopsy incidence of 0.2-0.9%. 1Transomental (greater or lesser) are rarer still accounting for less than 1% of all internal hernias and are usually a complication of previous surgical procedures. [2][3][4] Small bowel obstruction secondary to an internal hernia is a surgical emergency. Whilst abdominal radiographs and ultrasonography may be of some diagnostic use, CT scanning remains the gold standard. 3,5 ConclusionsThis case promotes the consideration and early recognition of internal herniae as a cause of abdominal pain in patients presenting to the emergency department. Despite the rarity We present the case of a 46-year-old man admitted with acute abdominal pain with no obvious cause despite simple investigations. Further imaging revealed a rare transomental internal hernia. At exploratory laparotomy, the hernia was released, no bowel resection was required and the patient was discharged 2 days later. ON-LINE CASE REPORT

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Strangulated transomental hernia: CT findings

Abstract: We report a case of surgically confirmed strangulation of small bowel through a defect in the greater omentum. Computed tomography demonstrated the presence and the location of this very unusual internal abdominal hernia. Those findings are presented.

Cited by 35 publications

References 5 publications

Internal Hernias: Clinical Findings, Management, and Outcomes in 49 Nonbariatric Cases

Internal Hernias: Clinical Findings, Management, and Outcomes in 49 Nonbariatric Cases

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

’The ins and outs of abdominal pain’: a case report of a transomental internal hernia

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