Transomental Hernia Causing Small Bowel Obstruction in a Virgin Abdomen: A Rare and Enigmatic Case

Background Internal hernias are an uncommon cause of small bowel obstruction, often presenting with nonspecific clinical features that can delay diagnosis. Among them, transomental hernias are the rarest subtype, accounting for approximately 1–4% of internal hernias. They typically occur secondary to prior abdominal surgery, trauma, or senile atrophy of the omentum. However, their occurrence in patients without any previous surgical history—referred to as a "virgin abdomen"—is exceedingly rare and presents a diagnostic challenge. Case presentation In this case report, we describe our experience of managing a case of acute small bowel obstruction as a result of transomental hernia which is later confirmed after emergency laparotomy on a 75 years old male patient with no past history of any surgical procedure, i.e. in a virgin abdomen. We also are highlighting the importance of maintaining a broad differential diagnosis in cases of unexplained bowel obstruction. Conclusion Spontaneous internal hernia as a cause of intestinal obstruction is very rare condition and challenging to diagnose preoperatively due to its nature of clinical presentation. Early Surgical intervention is required based on high clinical suspicion and imaging finding to minimize the risk of complication on late intervention.