Neonatal Lesser Omental Hernia Associated with Intestinal Malrotation and Congenital Duodenal Stenosis

Lesser omental hernia is a rare type of internal hernia. Almost all previously reported cases are adult patients and neonatal cases are extremely rare.

A 2-day old female baby was referred to our hospital due to vomiting with dark colored vomitus. The abdomen was slightly distended and enteral feeding failed to establish. A gastrointestinal series revealed intestinal malrotation, and the patient was taken to the operation room. Laparoscopic investigation revealed non-rotation type intestinal malrotation without volvulus. After extraction of the entire gastrointestinal tract via umbilical incision, the liver flexure part of the transverse colon was revealed to protrude to the inferior aspect of the liver through the dorsal area of the stomach, and a diagnosis of lesser omental hernia was made. The protruded colon was reverted to its normal position and the orifices were closed by suture. Additionally, duodenal stenosis with annular pancreas was found, which were corrected by diamond-shaped duodeno-duodenal anastomosis. A gastrostomy was made before the abdomen was closed. The perioperative course was uneventful and the baby was transferred to another hospital for congenital heart disease care.

Lesser omental hernias rarely occur congenitally. Careful exploration is necessary for neonatal gastrointestinal surgery, because rare abnormalities could occur. A 5-mm extension of the umbilical wound enabled exploration of the total alimentary tract without compromising cosmetic outcome.