Internal transomental herniation with a trapped small bowel mimicking acute appendicitis

Internal herniation with subsequent bowel obstruction is uncommon, and making a correct diagnosis prior to surgery is often difficult.

In this case report we present a man, who suffered from sudden extreme right-sided abdominal pain. The diagnostic workup was inconclusive. Emergency surgery was indicated with a suspicion of acute appendicitis. We found a strangulated ileus caused by an internal herniation of the small intestine through a hole in the greater omentum. The patient had no history of surgery or other physical disorders explaining this finding. The obstruction was resolved and the postoperative clinical course was uncomplicated.

A thorough diagnostic workup including CT scan would most probably have given the correct diagnosis. However, the clinical course and initiation of the correct treatment would have been delayed significantly.

We suggest that the diagnostic workup of patients with unclear lower abdominal pain should be limited and that acute clinical symptoms require rapid laparoscopic evaluation and surgical treatment.