An Unusual Internal Hernia Related to Appendix Epiploicae – A Case Study and Review of Literature

Soham U Dave, MA, OMSIII, Venkata K Kella, MD

Weirton Medical Center, West Virginia School of Osteopathic Medicine, Weirton, WV

Introduction: Internal hernia is an unusual cause of intestinal obstruction in nonbariatric patients. Transomental hernia is a rare type of hernia accounting for less than 1% of all internal hernias. Here we report a case study of an elderly male with a strangulated internal hernia related to appendix epiploicae.

Case Study: An 85-year-old previously healthy Caucasian male presented with a one day history of central abdominal pain and distension associated with nausea without vomiting. His past medical history is significant for hypertension, hypothyroidism, and dyslipidemia. Physical examination revealed stable vital signs and a mildly distended abdomen with normal bowel sounds and hernia orifices. Laboratory results were significant for mildly elevated WCC at 13,000. CT scan of abdomen without contrast revealed partial small bowel obstruction with transition at the mid ileum. Small bowel follow through with gastrografin confirmed small bowel obstruction. Initial conservative management with NPO and IV hydration was unsuccessful. Exploratory laparotomy revealed strangulated internal herniation of the jejunum through the defect between the omentum and its attachment to the appendix epiploicae on the left side of transverse colon. Segmental jejunal resection and side to side stapled jejunal anastomosis were performed. Post operative recovery was complicated by ventricular tachycardia and aspiration pneumonia. Cardiac work up was normal and pneumonia responded well to moxifloxacin. He was discharged home on the 10th post op day. Follow up at 1 month, he is well.

Conclusion: Small bowel obstruction due to internal transomental herniation through the defect related to appendix epiploicae, is rare. This is the second case study of its kind reported in English literature.


Session: Poster Presentation

Program Number: P310

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