Case Report: A small bowel occlusion revealed by a strangulated transomental hernia [version 1; peer review: awaiting peer review]

Introduction Transomental hernias are a rare type of internal hernia, accounting for less than 1% of all internal hernias. They occur when abdominal contents protrude through a defect in the omentum, leading to bowel obstruction and potential strangulation. We report the case of a young male admitted for the management of an acute bowel obstruction. Case report A 38-year-old male patient with no significant medical or surgical history presented with a proximal bowel obstruction syndrome. Upon physical examination, he exhibited mild abdominal distension, tenderness in the right iliac fossa, and tympanism. Laboratory tests indicated elevated inflammatory markers. An emergency computed tomography (CT) scan suggested the presence of a congenital band or an internal hernia. A laparoscopic procedure was performed, which identified a transomental hernia with a segment of the ileum protruding through an omental defect adjacent to the transverse colon. The herniated loop of small intestine was found to be compromised and gangrenous. Due to the severity of the condition, a midline incision was made to convert the procedure, allowing for resection of the affected segment of the small intestine while preserving 2.5 meters of viable bowel distal to the duodenojejunal junction. The remaining small intestine was exteriorized as a double-barrel ileostomy, and the transomental defect was subsequently repaired. The postoperative recovery was uneventful. Conclusion Although internal hernias account for a relatively small percentage of cases, they are frequently overlooked as a cause of bowel obstruction. Diagnosis this condition is challenging, both clinically and radiologically. Facilitating prompt surgical intervention to mitigate high mortality is essential.