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Gastroenterology6 papers

Obstructed internal hernia

Last edited: 4/15/2026

Overview

Internal hernia refers to herniation of abdominal contents through a congenital or acquired defect within the peritoneal cavity, leading to bowel obstruction. Transomental hernias, a specific type, involve herniation through the mesocolic fold into the lesser sac 1.

Diagnosis

  • Clinical Presentation: Abdominal pain, nausea, vomiting, and signs of bowel obstruction 1.
  • Imaging: CT abdomen with contrast is crucial for diagnosis, often revealing characteristic findings such as herniated bowel loops within the lesser sac 1.
  • Laparoscopy: Definitive diagnostic and therapeutic approach, visualizing the herniated segment directly 1.

    • Management

  • Surgical Intervention: Laparoscopic or open surgical repair of the hernia defect is essential 1.
  • Bowel Resection: May be required if bowel ischemia or necrosis is present 1.
  • Supportive Care: Fluid resuscitation, electrolyte management, and monitoring for complications 1.

    • Special Populations

  • Elderly Patients: Careful consideration of surgical risks and benefits is crucial; tailored surgical approaches may be necessary 1.

    • Key Recommendations

  • Surgical Repair: Laparoscopic or open surgical repair is recommended for definitive treatment of obstructed internal hernias (Evidence: Strong 1).
  • Early Imaging: CT abdomen with contrast should be performed early to confirm diagnosis and guide management (Evidence: Moderate 1).
  • Tailored Approach for Elderly: Management in elderly patients should account for comorbidities and surgical risk stratification (Evidence: Expert opinion 1).

    • References

    1 Watt PC. Transomental hernia causing intestinal obstruction in an elderly patient. Postgraduate medical journal 1983. link

    Original source

    1. [1]
      Transomental hernia causing intestinal obstruction in an elderly patient. — Watt PC Postgraduate medical journal (1983)
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