title: Strangulated internal hernia through the lesser omentum with intestinal necrosis: a case report.
abstract: BACKGROUND
  Internal hernias account for only 0.2 to 0.9% of the cases of intestinal obstruction. They do not have specific clinical manifestations, and are usually diagnosed during laparotomy for acute intestinal obstruction. Internal hernias through the lesser omentum are extremely rare.
  
  
  METHODS
  We report here the case of a 36-year-old patient who underwent exploratory laparotomy for acute intestinal obstruction. An internal hernia through the lesser omentum was found, with a strangulated ileal segment passing through the perforation into an abscess within the lesser sac. The surgical procedures included ileal resection, primary anastomosis, abscess removal, and placement of a drain in the lesser sac. The patient was reoperated 6 days later for abdominal sepsis; a lesser sac abscess was removed and the abdominal incision was left open. The patient stayed in the Intensive Care Unit for 15 days, and eventually left the hospital on the 28th post-admission day, with complete recovery thereafter.
  
  
  CONCLUSIONS
  The early diagnosis of acute intestinal obstruction and immediate indication for laparotomy is the main task of the surgeon when faced with a case of acute abdomen with a hypothesis of internal hernia, so as to minimize severe postoperative complications, as illustrated by the present case.
authors.affiliation: Emergency Surgery Department, 3rd Division of Clinical Surgery, Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Gustavo Gibin
authors.initials: GG
authors.lastname: Duarte
authors.forename: Belchor
authors.initials: B
authors.lastname: Fontes
authors.forename: Renato Sérgio
authors.initials: RS
authors.lastname: Poggetti
authors.forename: Marcos Roberto
authors.initials: MR
authors.lastname: Loreto
authors.forename: Paulo
authors.initials: P
authors.lastname: Motta
authors.forename: Dario
authors.initials: D
authors.lastname: Birolini
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology* / Q000601:surgery; D000328:Adult; D006555:Hernia, Ventral / Q000150:complications* / Q000601:surgery; D006801:Humans; D007077:Ileal Diseases / Q000150:complications* / Q000601:surgery; D007082:Ileum / Q000473:pathology*; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D008297:Male; D009336:Necrosis; D009852:Omentum; D010532:Peritoneal Diseases / Q000150:complications / Q000601:surgery