Herniation through both Winslow’s foramen and a lesser omental defect: Report of a case

Abstract

The herniation of small bowel through Winslow's foramen is a rare type of internal hernia which can cause ileus; however, a hernia traversing the lesser sac is even more unusual. To the best of our knowledge, only 25 cases of herniation through Winslow's foramen and 10 cases of lesser sac hernia have been reported in the Japanese literature. We describe herein the case of a 33-year-old man who presented to our hospital complaining of abdominal pain in whom a plain abdominal radiograph revealed small bowel gas with air-fluid levels, suggesting ileus. Following admission, an ileus tube was inserted, but the intestinal shadow did not improve and surgery was performed based on suspicion of an internal hernia. Approximately 100 cm of ileum was found to have herniated through a defect in the lesser omentum after passing through Winslow's foramen. Since the herniated bowel was viable, manual reduction without resection was performed. The patient had a satisfactory postoperative course, and was discharged on postoperative day 11. There are many unknown aspects surrounding the etiology of Winslow's foramen hernia and lesser sac hernia, and although internal hernia is a rare cause of ileus, its possibility should be kept in mind.

Left-Sided Paraduodenal Hernia: Report of a Case

“…A correct preoperative diagnosis may also help surgical planning in patients with altered anatomy, and assist in the differential diagnosis of other defined rare internal hernias. 16 Although attention should be paid to preserving the vessels forming the anterior wall of the hernia sac, they can be sacrificed if a safe repair is not possible without division of the inferior mesenteric vein.…”

Clinical spectrum of internal hernia: A surgical emergency

“…These hernias are often diffi cult to diagnose preoperatively, but their rapid progression to bowel ischemia presents a life-threatening emergency. 3,5,6,8,18,20,21,23,24 Therefore, we reported our 10-year clinical experience and attempted to defi ne the indicators of bowel ischemia in this rare but lethal disease. During the study period, internal hernia accounted for only about 1.1% (n = 20/1 827) of the causes of intestinal obstruction in our institution.…”

“…1,3,9,17,[19][20][21][22] However, most of these reports document individual cases, studies of a limited group, and reviews of a special type of internal hernia. These hernias are often diffi cult to diagnose preoperatively, but their rapid progression to bowel ischemia presents a life-threatening emergency.…”

“…Many types of CIH have been reported, including paraduodenal, transmesenteric, pericecal, transmesosigmoid, supra-or perivesical, Winslow's foramen, omental hernia, and rarely, hernia through the broad ligament, the mesoappendix, or the mesentery of a Meckel's diverticulum. 1,3,9,17,[19][20][21][22] In contrast, acquired internal hernia (AIH) arises from a prior surgically created entrapment such as a Roux-en-Y anastomosis, infl ammation or infectious process, and trauma. 1,18 We conducted this retrospective study to establish the related indicators of bowel ischemia in patients who underwent surgery for an internal hernia in our institution during a 10-year period.…”

Internal Hernias in the Era of Multidetector CT: Correlation of Imaging and Surgical Findings

“…Herniated intestine may exit from the lesser sac into the greater peritoneal cavity through an opening other than the entry point in rare cases (Fig 13). Several combinations of entry and exit sites have been reported (42,47,49,50).…”