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Transomental hernia resulting in a closed loop small bowel obstruction: delayed presentation following paediatric

Blanche Lee1, Andrew Evans2

  • 1General Surgery, Toowoomba Hospital, Toowoomba, Queensland, Australia blanche.lee@health.qld.gov.au.

BMJ Case Reports
|January 25, 2025
PubMed

Insights

Internal hernias, though rare in children, can cause acute abdomen after blunt trauma. Prompt diagnosis and surgical repair are crucial to prevent bowel strangulation and ischemia, as shown in a transomental hernia case.

Area of Science:

  • Pediatric Surgery
  • Abdominal Imaging
  • Trauma Surgery

Background:

  • Internal hernias are uncommon in pediatric patients.
  • Blunt abdominal trauma can precipitate internal hernias.
  • Prompt recognition is vital due to high risk of bowel strangulation and ischemia.

Purpose of the Study:

  • To highlight the importance of considering internal hernias in pediatric patients with acute abdomen post-trauma.
  • To report a case of transomental hernia (TOH) in a young girl following blunt trauma.
  • To emphasize the diagnostic and therapeutic approach for internal hernias.

Main Methods:

  • Case report of a young female patient presenting with acute abdominal pain 3 weeks after a motor vehicle accident.
  • Computed tomography (CT) scan to evaluate for small bowel obstruction and ischemia.
  • Urgent surgical intervention and laparoscopic reduction of the transomental hernia.

Main Results:

  • CT scan revealed a closed-loop small bowel obstruction with ischemic features, suggestive of internal hernia.
  • Surgical exploration confirmed a transomental hernia containing ischemic but viable small bowel.
  • Laparoscopic reduction of the TOH was successfully performed.

Conclusions:

  • Transomental hernias can occur following blunt abdominal trauma in children.
  • CT imaging is crucial for diagnosing internal hernias presenting as small bowel obstruction.
  • Laparoscopic surgery offers a successful treatment option for transomental hernias in pediatric patients.

Keywords:
General surgeryPaediatric Surgery

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