Spontaneous lesser omental herniation resolved by laparoscopic surgery: case report and systematic literature review

Abstract

Background: Despite its extremely low incidence, intra-abdominal herniation through the lesser omentum is associated with a high mortality rate and must be recognized early and treated urgently. To overcome a lack of data on the management of this condition, we collected and reviewed all the reported cases of operated lesser omental hernia and presented the case of a patient treated by laparoscopy for an isolated lesser omental hernia.

Methods: According to PRISMA guidelines and using PubMed, Cochrane Library, and Web of Science, a systematic literature review of cases of lesser omental hernia treated by surgery was performed on February 12, 2023.

Results: Of 482 articles, 30 were included for analysis and only 9 articles presented an isolated hernia through the lesser omentum. Among these, 4 patients were female and the median age was 38. Upper abdominal pain and vomiting were reported in 7 out of 9 patients. The small bowel was responsible for 78% (7/9) of all lesser omental herniations. All of them were treated by laparotomy. In addition, we describe the case of a 65-year-old woman without prior surgical history who was treated by laparoscopy for a spontaneous closed loop hernia through the lesser omentum without any other associated hernias.

Conclusion: Mostly associated with prior surgery or trauma, this type of herniation could sometimes occur spontaneously without any sign of peritonitis. Due to the high mortality rate, internal abdominal hernias should always be ruled out with a CT scan in front of patients presenting with persisting acute abdominal pain and no alternative diagnosis.

Keywords: Gastrohepatic omentum; Hernia; Intra-abdominal; Lesser omentum; Small omentum.

Fig. 1

Lesser Omental Hernias Classification according to Chen et al. L liver, S stomach, TC transverse colon, W foramen of Winslow, 1 Hernia through the greater omentum and through the lesser omentum, 2 Hernia through the foramen of Winslow and lesser omentum, 3 Hernia through the transverse mesocolon and the lesser omentum, 4 Hernia through the lesser omentum only

Fig. 2

65-Year-old female with isolated spontaneous lesser omental hernia

Fig. 3

A Abnormally positioned dilated small-bowel (SB) internal hernia between the liver (L), the stomach (S), the pancreas (P) and the gastro-hepatic ligament (yellow arrow) signing closed loop ileus in the lesser omental sac. B Lesser omentum after resolving the herniation by laparoscopy; *Lesser omentum defect (Color figure online)

Fig. 4

Flow diagram of searching eligible studies