Shlermine Aupont, MD, Emanuela Alvarenga, MD, Derek McCranie, BS, Alexander Ramirez, MD. Florida State University College of Medicine
Introduction: Laparoscopic approach in the acute surgical care setting continues to be underutilized. We aim to report the successful diagnostic and therapeutic use of laparoscopy in the management of a nontoxic patient presenting with acute abdomen and to highlight the benefits of a minimally invasive approach without added morbidity.
Case report: Presented is a 52-year-old male with history of CAD s/p CABGx4 two years prior and no abdominal surgical history who presented to the ED with sudden onset severe, diffuse, abdominal pain of six-hour duration with N/V. There was no trauma to the abdomen. He had mild-moderate hypertension, but was otherwise hemodynamically stable. On examination, the patient was in severe distress and writhing in pain. FAST exam was unable to be performed secondary to pain. CTA of the abdomen revealed mesenteric abnormalities with associated small bowel edema in the RLQ suspicious for small bowel ischemia. He was taken to the OR for diagnostic laparoscopy. He was found to have an omental adhesive band to the abdominal wall with herniation of the small bowel through the small opening. Approximately 70cm of ischemic, nonviable small bowel was resected and anastomosed intracorporeally. He tolerated the procedure well and was discharged home on post-operative day 3.
Discussion: Primary omental related internal herniation of small bowel is exceedingly rare. There have been only few cases reported in the literature (1,2,3,4). Two were diagnosed on exploratory laparotomy, one on diagnostic laparoscopy and one at autopsy. The one who underwent diagnostic laparoscopy did not require bowel resection. In presenting this case, we hope to illustrate the role of laparoscopy in the management of acute abdominal pain due to bowel compromise.
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4. Pilla, Mark & Byard, Roger. Omental adhesion, intestinal herniation, and unexpected death in the elderly. Forensic Sci Med Pathol. 2016;12(2):214-216
5. Sinwar PD. Small bowel obstruction secondary to greater omental encircling band–Unusual case report. Int J Surg Case Rep. 2015;10:204-205.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88125
Program Number: P704
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster