• Gustavo Gibin Duarte, Belchor Fontes, Renato Sérgio Poggetti, Marcos Roberto Loreto, Paulo Motta, and Dario Birolini.
• Emergency Surgery Department, 3rd Division of Clinical Surgery, Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil.
• Sao Paulo Med J. 2002 May 2; 120 (3): 848684-6.

ContextInternal hernias account for only 0.2 to 0.9% of the cases of intestinal obstruction. They do not have specific clinical manifestations, and are usually diagnosed during laparotomy for acute intestinal obstruction. Internal hernias through the lesser omentum are extremely rare.Case ReportWe report here the case of a 36-year-old patient who underwent exploratory laparotomy for acute intestinal obstruction. An internal hernia through the lesser omentum was found, with a strangulated ileal segment passing through the perforation into an abscess within the lesser sac. The surgical procedures included ileal resection, primary anastomosis, abscess removal, and placement of a drain in the lesser sac. The patient was reoperated 6 days later for abdominal sepsis; a lesser sac abscess was removed and the abdominal incision was left open. The patient stayed in the Intensive Care Unit for 15 days, and eventually left the hospital on the 28th post-admission day, with complete recovery thereafter.ConclusionThe early diagnosis of acute intestinal obstruction and immediate indication for laparotomy is the main task of the surgeon when faced with a case of acute abdomen with a hypothesis of internal hernia, so as to minimize severe postoperative complications, as illustrated by the present case.

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