Abstract
Transomental and transmesenteric hernias are rare types of internal hernia, with a reported frequency of upto 4% and 8%, respectively. Combined transomental and transmesocolic hernia is even rare. Only in a few types of internal hernia, the dilated small bowel loops will be seen extending from the antero-superior aspect of the distal stomach and cause stretching effect over the adjacent bowel loops with increase in the size of the herniated bowel segment or intestinal obstruction. We report a rare case of idiopathic combined transomental (across the lesser omentum) and transmesocolic internal hernia with "stretched bowel sign," its diagrammatic representations, and review of literature.