Internal Omental Hernia: A Rare Case of Small Bowel Obstruction

Abstract

Rezgui Bochra, Ben Dhaou Anis, Boukhchim Morthada, Mabrouk Aymen, Ouertani Emna and Ben Moussa Mounir

Introduction: Internal hernia represents an exceptionally uncommon occurrence of small bowel obstruction, with an incidence rate ranging from 0.2% to 0.9% and it is associated with a substantial mortality rate of approximately 45%, Trans-omental hernias are exceptionally uncommon, accounting for just 1–4% of all internal hernias. We report a case of a trans-omental hernia with obstruction due to a strangulated small bowel.

Case Report: A 67 year old man patient, Presented with symptoms of acute intestinal obstruction characterized vomiting, and abdominal pain., the abdominal examination showed abdominal distension with epigastric tenderness,, the abdominal computed tomography (CT) scan with contrast enhancement showed an intestinal obstruction in the right lower quadrant, with the presence of the beak sign, signifying the location of the small bowel obstruction (SBO) transition zone ,Emergency laparotomy surgery identified an entrapped segment of the small intestine protruding through a defect in the greater omentum The entrapped small intestine was successfully freed, and as the ileal segment remained viable, there was no need for bowel resection The patient remained in the Intensive Care Unit for duration of 15 days and was discharged from the hospital on the 28th day after admission, experiencing complete recovery thereafter.

Conclusion: In cases of acute abdomen suspected to involve internal hernia, the primary main task for the surgeon is the prompt identification of acute intestinal obstruction and an immediate recommendation for laparotomy. This approach aims to mitigate the risk of significant postoperative complications, as demonstrated by the current case.

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