A Rare Encounter: Small Bowel Obstruction Secondary to Transomental Internal Hernia

Abstract

Transomental (trans-epiploic) internal hernia is an exceptionally rare cause of small bowel obstruction (SBO), particularly in adults without prior abdominal surgery. Although internal hernias overall account for less than 1% of abdominal hernias, they contribute to approximately 5.8% of SBOs and can carry substantial morbidity and mortality when diagnosis is delayed due to non-specific clinical manifestations. Computed tomography (CT) is the diagnostic modality of choice and should be emphasized in early evaluation of suspected SBO without surgical history. Optimal management includes prompt resuscitation, urgent surgical exploration with reduction of the incarcerated bowel, resection of nonviable segments when indicated, and systematic closure of the omental defect to prevent recurrence. We report a 51-year-old male with acute abdominal pain and vomiting. Abdominopelvic CT revealed clustered, distended small bowel loops with a suspected transition point in the right para-umbilical region, without signs of ischemia. Emergency laparotomy identified a small bowel loop incarcerated through a trans-epiploic defect; the loop was reduced and the defect closed without resection. The postoperative course was uneventful; at one-month follow-up the patient was well. This case highlights the diagnostic challenge of internal hernias and the pivotal role of early CT and timely surgical intervention in improving outcomes, even when preoperative imaging does not show ischemia.