Strangulated internal hernia through the lesser omentum with intestinal necrosis: a case report.
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.
Duarte
Gustavo Gibin
GG
Emergency Surgery Department, 3rd Division of Clinical Surgery, Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil.
Fontes
Belchor
B
Poggetti
Renato Sérgio
RS
Loreto
Marcos Roberto
MR
Motta
Paulo
P
Birolini
Dario
D
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