Strangulation of the small intestine in holes in the great omentum. A report of two cases

Abstract

HERNIATION through the great omentum is rare, and when it occurs the omentum is usually already fixed to other viscera or to the abdominal wall, either by adhesions or by its inclusion in a hernial sac; herniation may also occur as a result of trauma. A review of the literature revealed only 20 recorded cases of spontaneous herniation of the intestine through a free great omentum. It was therefore deemed worth while to record a further 2 examples of this condition. CASE REPORTSCase I.-W. A. K., a male aged 39 years.On the morning of his admission, following breakfast, he complained of sudden severe colicky pain localized to the epigastrium. Two hours later the pain became more generalized, but less severe. The pain was accompanied by severe vomiting. The bowels acted in the morning, but this did not ease his pain and he did not pass flatus.During the previous six months he had complained of vague indigestion, consisting of an epigastric aching pain which might last the whole day.His past history was unrevealing and in particular he had not undergone any previous abdominal operation.ON EXAMINATION.-He was shivering and sweating and appeared ill. Temperature normal, pulse Solmin., blood-pressure 150/go. The abdomen was not distended and visible peristalsis was not present. There was generalized guarding, but local tenderness was absent and abnormal masses could not be palpated. Bowelsounds were absent. Herniae were not detected. Rectal examination revealed tenderness in the rectovesical pouch.AT OPERATION.-The abdomen was opened through an upper abdominal midline incision, and on entering the peritoneal cavity a moderate quantity of serosanguineous fluid was found. Further exploration revealed that a loop of jejunum 10 in. (25 cm.) in length had passed forwards through a hole in the great omentum near its free border. This loop was markedly thickened and dark red in colour. The defect in the great omentum was 2 in. (5 cm.) in diameter, and its lower border was formed by a slender strand t in. (6 mm.) thick. No adhesions or internal herniae were found.The band causing the obstruction was divided and the abdomen was closed. The patient made an uneventful recovery and was discharged on the eleventh day.Case 2.-G. H. L., a male aged 50 years. During the evening prior to admission he experienced sudden colicky pain in the centre of his abdomen, which

Transomental Herniation Mimicking Sigmoid Volvulus

“…with numerous fat-free lucent areas, has been reported on a previous occasion. 10 The underlying defect here might not be as Clark suggested, 16 but rather might relate to a developmental deficiency of omental mesenchyme. In this circumstance, the generalized attenuation might predispose to aperture formation, perhaps precipitated in this case by relatively minor trauma.…”