Laparoscopic repair of a strangulated internal hernia through the hepatogastric ligament

Internal hernias are a rare cause of small bowel obstruction, but they can lead to significant morbidity and mortality if left untreated, particularly in cases of strangulation. Herniation through the hepatogastric ligament, a component of the lesser omentum, is an exceedingly rare subtype. This report presents the case of a 44-year-old male who presented with worsening epigastric pain and was diagnosed with a strangulated internal hernia. Initial imaging with computed tomography (CT) suggested a closed-loop small bowel obstruction, with presumed herniation through the foramen of Winslow. Intraoperatively, the hernia was found to involve the hepatogastric ligament, a defect that was successfully repaired laparoscopically. This case highlights the pivotal role of CT imaging in the initial evaluation of internal hernias and the value of laparoscopy as both a diagnostic and therapeutic tool.