Introduction: Internal hernias account for 0.5–5.8% of small-bowel obstructions. Transomental hernia is the rarest subtype (1–4%). In a virgin abdomen, its mechanism usually remains unexplained.

Case Presentation: A 47-year-old woman with no surgical history presented with right upper quadrant pain. The first CT scan showed only nonspecific mesenteric fluid infiltration. Pain and vomiting recurred when oral intake was resumed. A second CT scan showed small-bowel obstruction with a fat notch sign and peritoneal effusion. Laparoscopy revealed 80 cm of small bowel volvulated through a defect in the greater omentum, close to the transverse colon. Division of the omental ring allowed reduction without bowel resection. The patient was discharged on postoperative day 4.

Discussion: The origin of omental defects in a virgin abdomen is debated: congenital defect, senile atrophy, or unnoticed past inflammation or trauma. CT, the reference examination, is often inconclusive at an early stage. Recurrent pain on refeeding should raise suspicion of intermittent incarceration, and a closed-loop mechanism with peritoneal effusion should prompt early surgery.

Conclusion: In small-bowel obstruction in a virgin abdomen, internal hernia should be considered early. Early exploratory laparoscopy is both diagnostic and therapeutic.