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Transomental hernias are the rarest subtype of internal hernias, accounting for 0.5%–3% of bowel obstructions. We report an unusual case of a spontaneous transomental hernia in a 47-year-old male presenting with non-specific obstructive symptoms. A CT scan revealed a closed-loop small bowel obstruction, but the diagnosis of a spontaneous transomental hernia was confirmed during emergency diagnostic laparoscopy. The small bowel remained viable, avoiding the need for resection, and the patient had an uncomplicated postoperative recovery. Clinical suspicion for transomental hernias is crucial, especially in patients with no prior abdominal surgery, to ensure early surgical intervention and reduced morbidity.

Abstract Transomental hernia is a rare cause of small bowel obstruction and may be missed before surgery, particularly in a virgin abdomen. We report a 75-year-old woman with no previous abdominal operation who presented with 4 days of abdominal pain, vomiting, distension, constipation, and reduced urine output. She had leukocytosis and acute kidney injury. Because of renal dysfunction, computed tomography was performed without intravenous contrast. It showed dilated ileal loops, a pelvic transition point, mild ascites, and twisting of mesenteric vessels at the transition point, suggestive of volvulus or closed-loop obstruction. Internal hernia was not diagnosed preoperatively. Emergency laparotomy revealed ileum strangulated through a 3 cm greater omental defect. Approximately 120 cm of gangrenous ileum was resected, the defect was excised, and single-layer extramucosal hand-sewn end-to-end anastomosis was performed. The case emphasizes that closed-loop obstruction in a virgin abdomen should prompt early consideration of internal hernia.

Abstract Transomental hernia (TOH) is an exceedingly rare subtype of internal hernia, often leading to acute small bowel obstruction with a high risk of ischemia. We present the case of a 58-year-old male with a history of laparoscopic inguinal hernia repair who developed abdominal pain, distension, vomiting, and obstipation. Contrast-enhanced computed tomography revealed clustered dilated ileal loops with a transition point suggestive of internal herniation. Exploratory laparotomy confirmed a TOH through the greater omentum without bowel ischemia. The defect was divided, and the postoperative course was uneventful. Due to its nonspecific presentation and diagnostic difficulty, TOH is frequently identified only at surgery. Prompt recognition and timely surgical management are essential to prevent serious complications.

Internal hernias (IH) are rare situations that account for 0.5–3% of all cases of intestinal obstruction. Transomental hernia is a rare subtype, hardly diagnosed, and represents approximately only 2% of internal hernias. In 2018, a 41-year-old female patient presented to Marmara University Hospital emergency service with abdominal pain, nausea, and vomiting. Her medical history included asthma, and she had no abdominal surgery. With the preliminary diagnosis of small bowel obstruction, laparotomy was done and showed a loop of ileum was herniated through into an unusual defect of the omentum. The obstructed loop of the small intestine into the hernia site was reduced. It was seen as viable, so no resection was necessitated. We divided the greater omentum into two parts from the edge of the defect area to prevent recurrences. The patient's postoperative period was uneventful, and she was discharged on the second postoperative day. Small bowel strangulation is more seen in transomental hernia than in other internal hernia types. So it is related to high morbidity and mortality. Surgery should not be delayed to reduce complications.

AbstractBackground: Transomental hernia (TOH) is a rare internal hernia, representing approximately 1–4% of all internal hernia cases. The spontaneous form, occurring in patients without a history of abdominal surgery or trauma, is exceptionally uncommon and presents a significant diagnostic challenge due to its nonspecific clinical features. TOH typically involves herniation of small bowel loops through a defect in the greater omentum. Case Presentation: We report a case of spontaneous TOH in a 76-year-old male undergoing chemotherapy for synchronous primary malignancies – left lung adenocarcinoma and right renal cell carcinoma – who presented with features of intestinal obstruction. Contrast-enhanced computed tomography suggested internal herniation with ischemia. Intraoperative findings confirmed approximately 100 cm of small bowel incarcerated through a 3-cm defect in the right side of the greater omentum. Age-related omental atrophy, along with chemotherapy-induced mesenteric fibrosis, microvascular injury, and impaired regenerative capacity, likely contributed to the defect formation. An emergency midline laparotomy was performed, involving resection of the gangrenous bowel and the creation of a double-barrel enterostomy. Postoperatively, distal enteral refeeding was critical in electrolyte correction, nutritional support, and early recovery. Discussion: TOH carries a high risk of strangulation and should be considered in elderly patients with bowel obstruction, even with no history of prior abdominal surgery, especially those receiving platinum-based chemotherapy. Conclusion: Although rare, TOH should be included in the differential diagnosis of acute abdomen in elderly oncology patients, even without previous abdominal surgery. Timely surgical intervention is vital to reduce morbidity and optimize outcomes.

PurposeA transomental hernia (TOH) is a rare type of internal hernia and is associated with a high strangulation rate and high mortality rate. Displacement of the transverse colon on computed tomography (CT) may be specific to a TOH and may facilitate an early diagnosis. The aim of this study was to verify the effectiveness of a novel approach assessing displacement of the transverse colon for the preoperative diagnosis of a TOH.Materials and methodsWe retrospectively reviewed the CT and operative data of 113 patients who underwent surgery for small bowel obstruction (SBO) between 2011 and 2018. The proportion of transverse colon loops posterior to dilated intestinal loops (PTPI) was calculated.ResultsThe patients were divided into a TOH group (n = 7) and other SBO group (n = 106). The median PTPI was significantly higher in the TOH group than in the other SBO group (67% [0–97%] vs. 0% [0–100%], Wilcoxon’s test, p = 0.03). A receiver operating characteristic curve showed that when the PTPI was ≥ 57%, its sensitivity and specificity for a TOH were 71% and 94%, respectively.ConclusionThe PTPI is a reliable quantitative measure to distinguish a TOH from other types of SBOs.

Background Transomental hernias are a rare type of internal hernia. We report two cases of successful cases of laparoscopic repair. One required laparotomy due to concern for intestinal viability. Case presentation The first patient was a 67-year-old man who presented with abdominal pain and vomiting. He had no history of laparotomy or abdominal injury. Computed tomography suggested small bowel obstruction and possible intestinal strangulation. Emergent laparoscopy found approximately 200 cm of small bowel was strangulated around the greater omentum. The strangulation was released laparoscopically, but because of the color of the strangulated bowel, laparotomy was performed to evaluate viability. The involved portion of intestine was not resected. The patient experienced transient postoperative paralytic ileus and was discharged on postoperative day 14. The second patient was a 56-year-old man who presented with abdominal pain. Abdominal computed tomography revealed dilatation of the small intestine and a closed loop suggesting ileus due to intestinal strangulation. An emergency laparoscopy found a transomental hernia, and the strangulation was released laparoscopically. Recovery was uneventful, and the patient was discharged on postoperative day 6. Conclusion Transomental hernia can be successfully treated laparoscopically. In cases where bowel viability is a concern, laparotomy should not be hesitated.

Background A transomental hernia is defined as bowel invagination into an abnormal hiatus of the omentum. It is a rare type of internal hernia that is sometimes lethal. We herein report a case of a transomental hernia developing shortly after laparoscopic sigmoidectomy. Case presentation A 71-year-old man underwent laparoscopic sigmoidectomy. He was admitted to our hospital because of abdominal pain and nausea on postoperative day 12. Laboratory investigation showed increased levels of inflammatory markers. Abdominal computed tomography showed a closed loop and mesenteric edema of the small intestine with ascites. We performed an emergency operation under the diagnosis of strangulated bowel obstruction. Operative findings showed internal herniation of strangulated ileal loops through a defect of the omentum with hemorrhagic ascites. The incarcerated small bowel was resected and reconstructed because the ischemic change was irreversible after the reduction. We partially resected the omentum that had formed the defect. The patient’s postoperative progress was good, and he was discharged on postoperative day 8. Conclusions Almost all internal hernias after intestinal surgery are mesenteric hernias; however, we should bear in mind that the more lethal transomental hernia is also possible. Therefore, immediate surgical exploration should be performed in a timely manner for internal hernias, especially for patients with early-onset symptoms after laparoscopic intestinal surgery.

Transomental hernia is the rarest form of internal hernias. Clinical expression of this pathology is ambiguous and diagnosis is often made at complication phase, after irreversible strangulation of the herniated loop. Radiological diagnosis is still difficult and intraoperative exploration usually allows discovering this pathology when patient is operated for acute intestinal obstruction. Treatment is surgical and aims to treat intestinal obstruction and prevent recurrence. We describe the case of a 65 years old male operated for a preoperatively suspected internal hernia; surgical exploration found a transomental hernia trough the greater omentum.

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.