Herniation of the caecum and ascending colon through the foramen of Winslow: a case report and review

Abstract

Approximately 5% of intestinal obstruction cases are caused by internal herniation. Caecal herniation through the foramen of Winslow is considered a rare event. The management of caecal herniation remains challenging due to the lack of literature highlighting this pathology. A 66-year-old woman was admitted with a 24-hour history of epigastric pain radiating to the back. The pain was associated with nausea and vomiting of gastric contents. On examination, the abdomen was soft with mild tenderness but no signs of peritonism or distension. The abdominal x-ray and a computed tomography were in keeping with caecal volvulus and confirmed that the caecum was not in the right iliac fossa. In a midline laparotomy procedure, the ileum, caecum and ascending colon were noted to be herniating into the foramen of Winslow. A right hemicolectomy with a handsewn anastomosis was performed. The foramen of Winslow was not closed. No postoperative complications occurred. A literature review showed a lack of similar cases with no agreed management consensus. The laparotomy approach is comparable to the laparoscopic approach and no caecal herniation recurrence after open/laparoscopic surgical procedures were identified. Awareness of caecal herniation allows early diagnosis and timely surgical management is needed in prevent patient morbidity and mortality.

Cecal bascule herniation through the foramen of Winslow

“…These cases include a cecal bascule herniation, cecal herniation along with the ascending colon and terminal ileum, cecal herniation with volvulus, and cecal herniation in the absence of a bascule. [6][7][8][9] To our knowledge, there are close to 20 reports of cecal herniation through foramen of Winslow (Table 1).…”

“…2,3,5 Once adequate exposure is obtained, the goal should be to reduce the hernia contents using dissection and gentle retraction. If the foramen 11 41 F Abdominal plain films Reduction of hernia with cecopexy 1974 11 56 F Abdominal plain films Reduction of hernia with cecopexy 1977 12 8 F Abdominal plain films/barium enema Laparotomy and partial resection of the ileum 1982 13 46 F Abdominal plain films/ultrasound Laparotomy with an appendicectomy 1989 14 84 F Abdominal plain films/barium enema Laparotomy with a right hemicolectomy 1991 15 32 F CT scan Laparotomy with cecostomy, cecopexy, and an appendectomy 2001 16 51 F Abdominal plain films Laparotomy with a right hemicolectomy 2009 17 60 F CT scan Laparoscopic hernia reduction 2010 18 45 F Abdominal plain films/CT scan Laparotomy with a right hemicolectomy 2010 19 49 F Abdominal plain films/CT scan Laparotomy with a right hemicolectomy 2013 10 62 M CT scan Laparotomy with a right hemicolectomy 2014 7 75 F CT scan Laparotomy 2016 20 38 F CT scan Laparotomy with an appendicectomy 2016 21 57 M CT scan Laparotomy with a right hemicolectomy 2019 6 56 F CT scan Laparotomy with a right hemicolectomy 2019 22 80 F CT scan Laparotomy with a right hemicolectomy 2019 8 66 F Abdominal plain films/CT scan Laparotomy with a right hemicolectomy 2020 11 69 M CT scan Laparotomy CT = computed tomography; F = Female; M = Male. along with marked bowel distention are well-known risk factors for development.…”

Caecal volvulus within the lesser sac: a rare cause of large bowel obstruction

“…Internal hernias are rare, accounting for 0.1% of all hernias, but cause an estimated 5% of intestinal obstructions 1,2 . Internal herniation through the foramen of Winslow is an uncommon occurrence, with a prevalence of up to 8% – therefore accounting for just 0.008% of all hernias 2,3 .…”

“…4 Patients often present with vague symptoms of upper abdominal pain, minimal distension and obstipation, with one case even describing gastric outlet obstruction as a consequence. 1,3,5,6 CT imaging has improved the early diagnosis of this condition and subsequently led to timely surgical care and reduced mortality. 7 Often, the most challenging aspect of operative management is reduction of the volvulus or internal hernia.…”

“…Internal hernias are rare, accounting for 0.1% of all hernias, but cause an estimated 5% of intestinal obstructions. 1,2 Internal herniation through the foramen of Winslow is an uncommon occurrence, with a prevalence of up to 8%therefore accounting for just 0.008% of all hernias. 2,3 A resulting caecal volvulus through the foramen of Winslow is a very rare event, with only 11 case reports identified on literature review, the first of these published in 1970 by William Moirika.…”