Adhesional Omental Hernia With Small Bowel Obstruction in an Elderly Patient With a Virgin Abdomen: A Case Report

Small bowel obstruction is a frequently encountered surgical condition in adults. Its most prevalent causes include adhesions resulting from prior abdominal surgery or peritoneal infection. However, cases of small bowel obstruction caused by omental bands in elderly individuals with no prior abdominal surgeries are exceedingly rare, with only a few reported in the literature. Here, we report a case of an elderly patient with small bowel obstruction caused by internal herniation through an omental band, without prior abdominal surgery or trauma. The initial impression was mesenteric ischemia, which posed a diagnostic dilemma as the patient did not exhibit any clinical risk factors for mesenteric ischemia with absent history of previous trauma or abdominal surgery. A computed tomography (CT) scan was performed, revealing clustering of small bowel loops in the right hemiabdomen with mild dilatation and a close loop configuration indicative of an internal hernia. Internal hernias are rare and challenging to diagnose clinically as they lack specific signs and symptoms. In this case, CT played a crucial role in enabling preoperative diagnosis of an internal hernia and guiding early management.