Strangulated obstruction caused by a transomental hernia

We herein report a rare case of a strangulated obstruction of the small intestine caused by a transomental hernia. A 66-year-old male was brought from another hospital by ambulance due to strangulated small bowel obstruction. He had no history of surgery. He had an acute onset of abdominal pain with nausea, vomiting and abdominal distension. Other symptoms were tachycardia, low blood pressure, abdominal tenderness in physical examinations, inflammatory changes, and metabolic acidosis in the blood analysis. Abdominal computed tomography showed a marked dilatation of the small intestine, which was poorly enhanced with massive ascites. In addition, no mesenteric vascular occlusion but the radial distribution of the mesentery anterior to the transverse colon was observed. A diagnosis of strangulated obstruction was made, and emergency surgery was performed. Intraoperatively, massive bloody ascites were observed and the small intestine was incarcerated through a hiatus of the greater omentum with necrosis. We performed an open incision of the hiatus to release the incarceration and then resected the necrotic portion. The postoperative course was favorable and the patient was discharged on hospital day 10. This case emphasizes the importance of internal hernias, including considering a transomental hernia as a potential cause of an interstinal obstruction in patients without a history of surgery. (