Small bowel obstruction caused by internal hernias occurs in 0.2 – 0.9% of cases. The objective of this case report is to present a rare case of internal hernia, known as double omental hernia.
A 39-year old female was admitted because of diffuse abdominal pain. She had acute onset of abdominal pain associated with bilious vomiting and abdominal distention. Scout film of the abdomen showed dilated small bowel loops at the upper abdomen. An acute abdomen probably due to a ruptured viscus was considered and exploratory laparotomy was done. Intraoperatively, a bloody ascites was noted, and segments of gangrenous small bowel (portion of jejunum and ileum) herniating to the lesser sac through a defect in the gastrocolic ligament, and exits the lesser sac through the gastrohepatic ligament. Small bowel resection of the gangrenous segment and end-to-end anastomosis of the remaining viable small bowel were done. Post-operatively, the patient experienced ileus lasting for 5 days, as manifested by bilious NGT output of more than 500 ml per day. Her diet was sequentially progress thereafter and was discharged on the 8th hospital day improved.
Internal hernias are uncommon entities and only few cases of double omental hernias were reported. The author claims that it is the first reported case in the Philippines and the 5th reported case in the world.