Trans-omental hernia as a rare cause of small bowel obstruction.

Internal hernia is a very rare case of small bowel obstruction (incidence: 0.2-09%) with a significant mortality rate of about 45%. It has few different forms including congenital or acquired and persistent or intermittent. According to its anatomic location, internal hernia has multiple different types. Trans-omental type is the rarest one that only accounts for 1-4% of internal hernia cases. It can be discovered incidentally but can also cause small bowel strangulation and obstruction with very high mortality rate. Based on presentation, immediate diagnosis and urgent surgical intervention are crucial to save the patient's life. Only very seldom cases o f trans-omentalhernia were reported in the literature that always had acute presentation. We report a very rare case of trans-omental hernia that started with slow presentation over decades with vague abdominal symptoms but then developed acute small bowel obstruction that necessitated immediate surgery.