Spontaneous transomental internal hernia causing small bowel obstruction in an elderly patient with a virgin abdomen:...

Internal hernias are a rare cause of small bowel obstruction (SBO), accounting for ~0.5%-5% of cases; transomental hernia represents the rarest subtype, comprising only 1%-4% of internal hernias. We report a 72-year-old man with hypertension but no prior abdominal surgery or trauma who presented with abdominal pain, nausea, and vomiting. Laboratory tests showed leukocytosis; abdominal radiography demonstrated air-fluid levels. Contrast-enhanced computed tomography revealed a collapsed colon, a distinct transition zone between dilated proximal and collapsed distal small bowel loops, and localized mesenteric fat stranding, suggesting internal hernia. After 48 h without improvement on conservative management, exploratory laparotomy revealed a 3-cm circular defect in the greater omentum with a herniated, viable small bowel loop causing closed-loop obstruction. The loop was reduced and the defective omental segment resected without bowel resection. The patient recovered uneventfully and was discharged on postoperative day 3.