TWO CASES OF TRANSOMENTAL HERNIA

Abstract

Case 1: A 64-year-old male patient was admitted to our hospital with chief complaints of abdominal pain, a feeling of abdominal satiety and vomiting. Barium enema examination presented an image of stenosis with a smooth periphery in the sigmoid colon, marked dilation on the oral side of the stenosis, and a return to the stenotic area describing an arc. Laparotomy performed in consideration of possible torsion of the sigmoid colon on its own axis revealed that the sigmoid colon impacting into a hiatus about 10cm in the longer diameter, located near the left free end of the greater omentum, was strangulated. Case 2: A 68-year-old male patient was admitted to our hospital with chief complaints of abdominal pain and vomiting. Laparotomy performed on the basis of the diagnosis of ileus revealed that the ileal area 150cm distant from the ileocecal valve was impacted into a hiatus about 3cm in diameter located on the left free end of the greater omentum and was strangulated. In both cases, the greater omentum including the hiatus was partially excised after rearrangement of the intestine. Although preoperative diagnosis of transomental hernia is impossible, the possibility of an internal hernia such as in our cases should be considered when the physician is faced with ill-defined ileus. Moreover, it is important to perform the surgery before it is too late.