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Transomental defects as a cause of chronic abdominal pain, the role of diagnostic laparoscopy: a case series.


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Authors

Ariyarathenam, Arun V 
Tang, Tjun Y 
Nachimuthu, Senthil 
Koak, Yashwant 
Harris, Adrian M 

Abstract

INTRODUCTION: Transomental herniation is a rare but recognised clinical condition, which usually presents as an emergency with bowel obstruction. It accounts for 1-4% of intra-abdominal herniations. We reviewed 3 patients found to have a transomental defect during elective diagnostic laparoscopy performed for chronic abdominal pain. To our knowledge, there is no case series reported in the literature on transomental defect in the non-emergency situation. CASE PRESENTATION: A retrospective case note analysis of 3 patients, found to have transomental defect during elective diagnostic laparoscopy, was undertaken. Data were gathered with respect to clinical presentation, investigations performed, transomental defect size and outcome of surgery. All patients were followed up for 6 months post-operatively. Three females (age range 18-35 years) were referred with a 3-10 year history of chronic intermittent abdominal pain, often postprandial. Blood tests, radiological investigations (ultrasound, magnetic resonance imaging/computed tomography, small bowel studies) and endoscopy were all normal. In each case, diagnostic laparoscopy revealed the presence of a peripheral defect in the greater omentum, but no actual small bowel herniation. No other pathology was found. These defects were resected, which subsequently led to complete resolution of the patients' symptoms. CONCLUSION: Chronic abdominal pain of unknown aetiology with normal radiological findings may be caused by intermittent obstruction due to small bowel herniation through a transomental defect. This should be considered during elective diagnostic laparoscopy, in the absence of any other obvious pathology. The omentum should be thoroughly inspected as a discrete entity and any such defects should be closed or resected.

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Keywords

32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, Pain Research, Digestive Diseases, Biomedical Imaging, Chronic Pain, Clinical Research, Rare Diseases, Neurosciences, 2.1 Biological and endogenous factors, 4 Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, 2 Aetiology, Oral and gastrointestinal

Journal Title

Cases J

Conference Name

Journal ISSN

1757-1626
1757-1626

Volume Title

Publisher

Springer Science and Business Media LLC