Strangulated Internal Hernia through the Lesser Sac ? An Unusual Cause of Small Bowel Obstruction

Introduction: The incidence of internal hernias is 0.2% to 2%. It is a rare cause of intestinal obstruction and leads from 0.5 to 4.1% of acute obstruction cases caused by hernia. Presentation of Case: We report a case of internal hernia traversing the lesser sac with a primary defect in the greater omentum and a second defect in the lesser omentum, causing small bowel obstruction which is extremely rare. Discussion: The most common causes of small bowel obstruction in adults are adhesions bands, malignancy and hernias. Internal Hernia (IH) is defined as herniation of viscera through a normal or abnormal aperture within the peritoneal cavity. Internal hernias are infrequent, accounting for 0.2 to 0.9% of the cases of intestinal obstruction. Transomental hernias through the greater or lesser omentum are even rarer, representing 1 to 4% of all internal hernias, with hernias occurring through both the omentum being extremely rare as in our case. Conclusion: When a case of acute intestinal obstruction is reported, after ruling out the known causes of obstruction, surgeon should have high suspicion of internal hernia to reduce the risk of intestinal ischemia, necrosis and perforation; thus decreasing the postoperative morbidity and mortality.