A Case Report of a Cecal Bascule with Internal Herniation through the Foramen of Winslow

Internal hernias are a rare phenomenon, and even rarer is a herniation through the foramen of Winslow. We report a rare case of an 81 year old female presenting with vague abdominal symptoms who was found to have a cecal bascule herniating through the foramen of Winslow treated with surgery.

Cecal herniation through the foramen of winslow: Case presentation and literature review

Foramen of Winslow hernias are a rare type of internal hernia that account for less than 1% of all cases of intestinal obstruction. It is extremely rare surgical condition with estimated mortality of about 50%. Timely diagnosis aided by computed tomography (CT scan) can facilitate proper planning and surgical treatment. Optimal treatment depends on patient’s condition, status of the incarcerated structure as well as surgeon’s comfort and preference.

205 Internal Herniation of The Caecum and Ascending Colon Through the Foramen of Winslow: A Case Report

Introduction An internal hernia occurs when part of the bowel protrudes through a mesenteric or a peritoneal orifice which could be either normally present or acquired. These hernias usually represent a challenge to diagnose. Of the natural anatomical orifices is the Foramen of Winslow through which the caecum and the ascending colon could herniate. Case Report An 85-year-old gentleman presented with a one-day history of abdominal pain. His pain had a sudden onset, an intermittent course and was limited to the epigastric region. He was nauseated but not vomiting. He had opened his bowels a day before presenting to the hospital. CT scan of the revealed herniation of the caecal pole through the foramen of Winslow and into the lesser sac. The decision was made to perform a laparotomy where it was revealed that the caecum and part of the ascending colon had herniated through the foramen of Winslow. Content of the hernia, which was viable, was carefully reduced and right hemicolectomy was performed. Conclusions With the scarcity of similar cases, we currently have no consensus of management. Dealing with the hernia at laparotomy would be usually the choice of the surgeon depending on tissue viability and other operative findings.

Foramen of Winslow hernia: an open approach

Foramen of Winslow hernia (FWH) are considered rare even among other internal hernias. It was first described in 1834 and historically had a mortality rate of close to 50%. With modern advancement and availability of cross-sectional imaging, this number has improved dramatically to 5%. Operative management is required for all patients which can be performed with either an open or laparoscopic approach. Preventative measures for recurrence remain controversial as no case of recurrence has been reported to date. We present a case study of a 62 years old woman who presented to the emergency department with severe epigastric pain and a CT scan confirming an FWH. She underwent urgent laparotomy and the hernia was easily reducible without need of intestinal resection. We opted to fixate the right colon and close the foramen of Winslow to prevent future recurrence. She recovered from her surgery well and was discharged home without any complications.

Laparoscopic surgery in a patient with foramen of Winslow hernia due to large uterine fibroids: a case report and literature review

Background Foramen of Winslow hernia (FWH) is a rare but emergent condition caused by an increase in the foramen diameter, visceral mobility, and intra-abdominal pressure. To the best of our knowledge, this is the first study to report a case of FWH secondary to large uterine fibroids that was successfully treated with laparoscopic surgery. Case presentation A 52-year-old woman with large uterine fibroids was diagnosed with FWH. Because of the absence of signs of bowel ischemia and peritonitis, we performed an elective laparoscopic surgery through a 5-port system after bowel decompression using a long intestinal tube. Although foramen of Winslow closure was not performed, her postoperative course was uneventful. Conclusions Laparoscopic surgery for FWH is considered an extremely effective surgical treatment option because of its safety and efficacy in performing delicate procedures (such as adhesiolysis) with a good magnified field of view.

Intestinal obstruction due to small bowel herniation through foramen of Winslow: a case report

Background Intestinal obstruction due to internal herniation of the bowel is a rare clinical entity which is often overlooked in the differential diagnosis of patients with abdominal pain who have no previous history of abdominal surgery. Several sites of bowel internal herniation have been described, amongst which internal herniation through the foramen of Winslow accounts for about 8% of cases. These patients present with nonspecific abdominal pain associated with symptoms of gastroesophageal reflux disease, and hence the diagnosis is often overlooked. The usual symptoms of intestinal obstruction can be delayed, which results in a delay in diagnosis and gangrene of the herniated bowel segment. Abdominal radiographs and computed tomography are helpful in the diagnosis. Open reduction is the management of choice; however, laparoscopic reduction has also been attempted, with good results. Case presentation We report a case of a middle-aged Sri Lankan man who presented with features of gastroesophageal reflux disease, developed features of intestinal obstruction and was found to have a gangrenous small bowel loop which had herniated through the foramen of Winslow. Following needle aspiration and reduction of the herniated small bowel loop, the gangrenous part of the small bowel was resected and an ileoileal anastomosis performed. The large foramen of Winslow was partially closed with interrupted stitches. The patient made an uneventful recovery. Conclusion Since delayed diagnosis of bowel obstruction is detrimental, it is of utmost importance to diagnose it early. Because internal herniation of the small bowel through the foramen of Winslow presents with nonspecific symptoms including features of gastroesophageal reflux disease, as documented in several cases worldwide and also presented by our patient, there should be a high degree of suspicion of internal herniation of the bowel causing bowel obstruction and low threshold for extensive investigation of patients presenting with symptoms of gastroesophageal reflux disease which does not resolve with usual medication.

Laparoscopic repair of incarcerated transverse colon internal hernia in a patient with Crohn’s disease

Internal hernia is a rare cause of bowel obstruction in patients with no prior surgical history. Laparoscopic repair of a transverse bowel herniation through the foramen of Winslow is the rarest type of internal hernia, with only two case reports published in the literature. In a patient with a history with Crohn’s disease and no prior surgical history, presenting with signs of bowel obstruction, and no inflammatory symptoms, internal hernia should be suspected as one of the causes. Minimally invasive laparoscopic repair is a feasible safe option in those patients, allowing patients to go home the next day postoperatively.