Faculty of Medicine, University of Geneva, 1211, Geneva, Switzerland.
Department of Surgery, Neuchâtel Hospital Network, Maladière 45, 2000, Neuchâtel, Switzerland.
Surg Endosc. 2023 Sep;37(9):6704-6710. doi: 10.1007/s00464-023-10279-4. Epub 2023 Jul 21.
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.
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.
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.
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.
尽管内疝通过小网膜的发病率极低，但死亡率很高，必须早期发现并紧急治疗。为了克服对这种疾病处理数据缺乏的问题，我们收集并回顾了所有报告的手术治疗小网膜疝病例，并报告了一例通过腹腔镜治疗孤立性小网膜疝的患者病例。
根据 PRISMA 指南，并使用 PubMed、Cochrane 图书馆和 Web of Science，于 2023 年 2 月 12 日对手术治疗小网膜疝的病例进行了系统的文献回顾。
在 482 篇文章中，有 30 篇被纳入分析，只有 9 篇文章报道了孤立性小网膜疝。其中，4 名患者为女性，中位年龄为 38 岁。7 名患者中有 7 名出现上腹痛和呕吐。小肠占所有小网膜疝的 78%（7/9）。所有患者均行剖腹手术治疗。此外，我们还描述了一位 65 岁女性的病例，她没有手术史，因自发性闭袢性疝通过小网膜而接受腹腔镜治疗，无任何其他疝。
这种类型的疝大多与既往手术或外伤有关，但有时也可能在没有腹膜炎迹象的情况下自发发生。由于死亡率高，对于表现为持续性急性腹痛且无其他诊断的患者，应始终通过 CT 扫描排除内脏内疝。
