Laparoscopic Management of Small Bowel Obstruction and Ischemia Caused by Spontaneous Transomental Hernia in a Virgin Abdomen: A Case Report.

Transomental hernias (TOHs) are a rare form of internal hernia, accounting for ~1%-4% of all internal hernias and 0.5%-3% of bowel obstructions. Preoperatively diagnosing TOH is challenging owing to nonspecific obstructive symptoms and the absence of a hernia sac. This challenge can lead to delayed interventions and increased risk of bowel ischemia. In this report, we present the case of a 71-year-old female patient with a negative surgical history who presented with small bowel obstruction and a high lactate level. Abdominal computed tomography (CT) showed a closed-loop obstruction with wall thickening and decreased enhancement, raising concerns of ischemia. Laparoscopic exploration revealed spontaneous TOH through the greater omentum, resulting in small bowel obstruction and ischemia, which were successfully managed entirely with laparoscopic resection, anastomosis, and closure of the mesenteric defect. The patient's postoperative course was uneventful. This report discusses diagnostic challenges, surgical approaches, and key intraoperative findings.