A Case of Greater and Smaller Transomental Sac Hernia

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 34; no. 8; pp. 1489 - 1492
• Main Authors: Sakata, Haruhito, Suzuki, Takao, Shimizu, Eiichiro, Fujita, Kazue, Mori, Mikito, Matsubara, Hisahiro
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Abdominal Emergency Medicine 31.12.2014
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem.34.1489

We experienced a rare case of transomental sac hernia invagination through a hiatus of the greater and smaller omentum and which had prolapsed to the abdominal free space through a hiatus of the lesser omental bursa, resulting in strangulation. A 16-year-old female was admitted to our hospital with prolonged pericardial pain. The X-ray findings revealed the niveau sign in the small intestine. Computed tomography showed dilatation of the small intestine due to obstruction and decrease of enhancement effect of the intestinal wall. Because of these radiological findings and the lack of the past history of laparotomy and injury, an emergency laparotomy was performed under a diagnosis of strangled intestinal ileus of the small intestine. At the time of the laparotomy, the ascending colon was free from the posterior abdominal wall and about 150 cm of the small intestine had invaginated through the defect of the greater and smaller omentum and prolapsed from the hiatus of the small omental bursa, locked by Bauhin’s valve. The ileocecal and the necrotic small intestine was resected. The postoperative course was uneventful. Internal hernias, such as transomental hernias, must be kept in mind as a high risk of strangulated ileus and should be treated as an emergency.