Transomental Hernia: Rare Presentation in a Virgin Abdomen

Internal hernias are characterized by the protrusion of abdominal viscera through congenital or acquired apertures within the abdominal cavity and are a recognized etiology of intestinal obstruction. Internal hernias can cause symptoms ranging from mild abdominal discomfort to complete intestinal obstruction. Transomental hernias are often associated with postoperative anatomical changes and are rare in patients without prior abdominal surgeries. This report details one case of a 31-year-old otherwise healthy female with no history of prior surgery, highlighting the clinical variability associated with internal hernias.  The patient presented with severe epigastric pain and nausea, with initial ultrasound findings unremarkable. Hours later, she returned with left iliac fossa pain and vomiting. A CT scan of the abdomen with contrast showed free fluid and dilated bowel loops, suggestive of small bowel obstruction. Emergency laparoscopy revealed small bowel herniation through a congenital omental band and ischemia, which resolved after the band was released. The patient recovered uneventfully and was discharged on day three. Transomental herniation exhibits nonspecific clinical symptoms of bowel obstruction. Radiographic presentations are generally nonspecific; however, a conclusive diagnosis is typically reached during surgery, where the detection of gangrenous bowel tissue is common, especially during exploratory laparoscopy. The postoperative mortality is largely attributed to bowel necrosis and delays in initiating treatment. This emphasizes the significant risk posed by undiagnosed cases and the critical importance of timely and effective intervention.