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The article presents a case study of a 63 year old woman in the U.S. who was taken to the emergency department because of acute-onset epigastrc pain. She was physically examined and it shows that she has unbeatable blood pressure, peritonitis and has increased serum lactate level. The article discusses internal hernia. It also states that transomental hernia is a rare case and that the presence of small-bowel loops associated with stretched vascular pedicle indicates a sign of internal hernia.