A rare case of internal small intestinal strangulation

Although internal abdominal hernias cause acute intestinal obstruction in no more than 6% of cases, the lethality associated with them reaches 50% in case of untimely diagnosed strangulation and gangrene of the intestine. The rarest type of such hernias is a transomental hernia, which occurs in 1-4% of cases. The diagnosis is difficult when such hernias are strangulated; therefore, they require an emergency operation at the slightest suspicion. In this report, we describe a case of internal small intestinal strangulation in the abnormal transomental aperture, accompanied by clinical features of strangulation intestinal obstruction without any findings during an instrumental examination.

Internal hernias occur in the peritoneal recesses or folds when a hollow organ, most commonly the small intestine, protrudes through a normal or abnormal aperture in the peritoneum or mesentery. Such hernias do not have specific clinical features and, as a rule, are diagnosed when acute intestinal obstruction occurs. The most common types of internal hernias are paraduodenal (53%), pericecal (13%), foramen of Winslow (8%), transmesenteric (8%), and intersigmoid (6%). Transomental hernias are the rarest (1-4%). We describe an internal small intestinal strangulation in the abnormal aperture of the greater omentum without any findings during an instrumental examination.

Although internal abdominal hernias cause acute intestinal obstruction in no more than 6% of cases, the lethality associated with them reaches 50% in case of untimely diagnosed strangulation and gangrene of the intestine. The rarest type of such hernias is a transomental hernia, which occurs either spontaneously or as a result of tension and increased intraabdominal pressure. Such defects in the greater omentum can be congenital, traumatic, or due to inflammatory changes, atrophy, etc. Perhaps, in our case, the cause of its formation in the thinnest portion of the greater omentum was abdominal hypertension due to the lifting of the heavy object by the emaciated person.

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