What You Need to Know About Lesser Sac Hernia

Understanding the Causes of Lesser Sac Hernia

A lesser sac hernia, also known as an internal hernia involving the lesser omental bursa, can occur due to several underlying factors. One of the most common causes is an abnormally long small bowel mesentery, which allows greater mobility of the intestines within the abdominal cavity. When the small intestine moves excessively, it may pass through the omental foramen into the lesser sac, resulting in a herniation.

Other Contributing Factors

Another significant cause is congenital intestinal malrotation, often accompanied by poor intestinal fixation. In such cases, the intestines may not be properly anchored, increasing the risk of internal herniation through the lesser sac. Additionally, abnormal peristalsis or a sudden increase in intra-abdominal pressure can also contribute to this condition.

Symptoms and Clinical Presentation

Patients with a lesser sac hernia typically experience acute upper abdominal pain, nausea, and vomiting. They may also develop symptoms of bowel obstruction, including the cessation of flatus and bowel movements. On physical examination, tenderness in the upper abdomen is commonly noted, and auscultation may reveal high-pitched bowel sounds or the characteristic "fluid wave" sound associated with intestinal blockage.

Complications and Emergency Signs

In more severe cases, bowel sounds may diminish or disappear entirely, signaling possible bowel ischemia or necrosis. If peritonitis develops, signs such as rebound tenderness, guarding, and the presence of turbid fluid upon paracentesis may be observed. Patients may also exhibit signs of systemic shock, including hypotension and tachycardia, indicating a life-threatening situation.

Diagnosis and Treatment

Immediate surgical intervention is required for the treatment of a lesser sac hernia. This condition is considered a surgical emergency due to the high risk of bowel strangulation and necrosis. Imaging studies such as CT scans may help confirm the diagnosis, but prompt clinical evaluation and operative management are crucial to prevent complications and ensure a favorable outcome.