Sigmoid Volvulus Through a Transomental Internal Hernia: A Novel Observation Misdiagnosed Simple Sigmoid Volvulus

Abstract

Sigmoid volvulus is the torsion of sigmoid colon around its mesenteric axis. It is a common cause of colonic obstruction in our regions. It requires a prompt and emergency management due to the high risk of occurrence of strangulation. As for internal hernia, it is a protrusion of a hallow viscus through an intraperitoneal defect. Its incidence is very rare and the prevalence of intestinal obstruction for an internal hernia is very low. However, this condition is associated with a high mortality when strangulation of the viscus occurs. The peritoneal defect can be localized in multiples places. From the various locations of the peritoneal defect, transomental defect is one of the rarest. This transomental defect may be congenital or acquired. It is known that the small bowel, due to its high mobility, most of the time herniates and volvulates through the defect. But, a redundant sigmoid colon may herniate and volvulate through an omental defect. The occurrence of sigmoid volvulus though a transomental defect is very rare and few cases have been reported in the literature. This condition requires prompt diagnosis and emergency surgery. The preoperative diagnosis may be tricky. Frequently the diagnosis is made at surgery. We report a novel observation of sigmoid volvulus through a transomental (great omentum) hernia missed on investigations, delaying thus the treatment which is based on an emergency surgery.