EC Clinical and Medical Case Reports

Introduction: Internal hernia is a protrusion of small bowel through intraperitoneal defect, even though it is relatively a rare condition, it is highly associated with morbidity and mortality and exploratory laparotomy found to be a diagnostic and life-saving management.

Case Presentation: The patient presented to emergency department as a case of acute abdomen. Based on series of investigations the preoperative diagnosis was intestinal obstruction. Intraoperative diagnosis was found to be transomental hernia with 50 cm of small bowel ischemia. Bowel resection with side-to-side anastomosis was done, followed by resection of omental defects.

Discussion: Despite the high rate of morbidity and mortality associated with internal hernia, an accurate preoperative diagnosis is challenging. However, lack of omental fat between the loops and the anterior abdominal wall found to be the most specific sign in computed tomography (CT) for diagnosing transomental hernia. The management of internal hernia is operative, with resection and anastomosis for the associated devitalized bowel.

Conclusion: Early surgical intervention is mandatory in the presence of clinical suspicion of internal hernia to avoid bowel ischemia and to provide a better prognosis.

Keywords: Intestinal Obstruction; Computed Tomography (CT); Transomental Hernia; Omentum

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