Spontaneous omental hernia posing a diagnostic challenge in a patient with multiple hernias: a case report

Introduction and importance: Spontaneous transomental hernias are the rarest cause of small bowel obstruction (SBO), accounting for 1–4% of SBO, and are mostly reported in adults >50 years. The symptoms are nonspecific, and a CT scan is essential for a preoperative diagnosis, although a handful of cases are still diagnosed intraoperatively. Case presentation: We present the case of a 75-year-old female with multiple hernias alongside a spontaneous closed-loop transomental hernia involving 15 cm of distal ileum that was only diagnosed during a laparotomy. Clinical discussion: The presence of other groin and abdominal wall hernias, as well as an anuric acute renal injury, further delayed the diagnosis of the internal hernia. A delay in diagnosis is often associated with bowel gangrene, resulting in increased morbidity and mortality. Conclusion: Spontaneous omental SBO is a rare cause of SBO that requires a high index of suspicion and a low threshold for surgery to reduce morbidity.