| disease | Transperitoneal Hernia |
| alias | Lesser Omental Sac Hernia |
Transomental hernia, also known as lesser omental sac hernia, occurs when a free loop of small intestine (occasionally the transverse colon) enters the lesser omental sac through a defect in the gastrocolic ligament, hepatogastric ligament, or transverse mesocolon caused by trauma or surgery, or through a small opening in the lesser omentum.
bubble_chart Clinical Manifestations
The manifestations often include acute episodes of abdominal pain, predominantly in the upper abdomen, which may present as severe, persistent distending pain or colicky pain, with possible radiation to the back. Accompanying symptoms include nausea and frequent vomiting, with vomitus consisting of bile-stained gastric contents, and absence of flatus or bowel movements. Examination may reveal upper abdominal fullness, often with a palpable cystic mass in the left upper quadrant, localized tenderness, rebound tenderness, and abdominal muscle rigidity. In severe cases, the pain may progress to involve the entire abdomen, with shifting dullness, hyperactive borborygmi, and high-pitched bowel sounds. Paracentesis may yield pale yellow exudate or bloody effusion. Complications can include severe electrolyte imbalances, intestinal necrosis, and toxic shock.
bubble_chart Auxiliary Examination
1. X-ray examination reveals the following characteristics: ① Distended intestinal loops can be seen in the upper abdomen; ② Multiple or single fluid levels may be present in the lesser omentum sac; ③ If it is difficult to distinguish gas-fluid levels in the stomach, observation can be made after gastrointestinal decompression; ④ In addition to gas accumulation in the stomach, there is another round area of gas accumulation in the upper abdomen; ⑤ The gastric body may be displaced to the left and compressed, resulting in deformation.
2. B-ultrasound examination may indicate the presence of distended intestinal loops in the lesser omentum sac, with loss of movement in the affected intestinal segments.Based on the clinical presentation of acute onset abdominal pain accompanied by symptoms of high intestinal obstruction, diagnosis can be easily made through X-ray and B-type ultrasound examinations.
bubble_chart Treatment Measures
The only treatment is emergency surgery. During the procedure, intestinal decompression should be performed first when reducing the bowel, and the decision to preserve or resect the intestine should be based on its viability after reduction. Then, the mesh should be sutured with high porosity or repaired with a large mesh to prevent recurrence.
