Internal hernia through the foramen of Winslow

Abstract

Foramen of Winslow hernias are one of the most uncommon types of internal hernias that a surgeon will encounter. They are often initially indolent with vague symptoms that present over an extended period of time. Unfortunately, these hernias are not often diagnosed prior to requiring emergent operative intervention. This case report describes a patient who had a long history of vague abdominal pain and radiographic evidence of a foramen of Winslow hernia 4 years prior to presenting with acute obstructive symptoms. This raises the question: Should foramen of Winslow hernias, if diagnosed early, be repaired on an elective basis?

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

“…As mentioned above, the diagnosis of a foramen of Winslow internal hernia is often not confirmed until in the operating room, so surgical intervention is necessary to diagnose and treat the problem. The surgical management requires reduction in the presence of obstructive symptoms with care to evaluate the herniated bowel for non-reversible ischemia (3,7). Surgical options after reduction of the internal hernia if the bowel is viable is a right hemicolectomy, an appendectomy with cecopexy, or hernia reduction with a cecostomy (6).…”

“…Surgical options after reduction of the internal hernia if the bowel is viable is a right hemicolectomy, an appendectomy with cecopexy, or hernia reduction with a cecostomy (6). A right hemicolectomy is often performed in order to limit the chance of a recurrence of both an internal hernia and cecal bascule or cecal volvulus (6,7,8). However, there has been no consensus on standard operative intervention as this is a very rare surgical finding, but a right hemicolectomy is most often performed.…”

“…In terms of reducing the internal hernia, it is often accomplished via gentle traction. However, opening of the lesser sac, enlarging the foramen via a Kocher maneuver, and/or needle decompression may be needed to facilitate reduction if there is massive colonic dilatation (7,8). Closure of the foramen of Winslow is often advocated against to prevent a recurrence due to the risk of portal vein thrombosis or damage to the portal triad (4,8).…”

Laparoscopic management of an ascending colon hernia through the foramen of Winslow

“…A computed tomography helps practitioners to the diagnosis of HFW and to the viability of the herniated contents [ 4 , 2 ], which allows the surgeon to consider a laparoscopic approach. Despite this, HFW is diagnosed preoperatively in less than 10% of the cases [ 5 , 6 ]. Laparoscopic management in case of internal hernia can be used as much as diagnostic than therapeutic, when possible, and propose enhanced recovery after surgical intervention.…”

Meckel’s Diverticulum in Foramen of Winslow Hernia – A Rare Cause of Bowel Obstruction

“…FOWH accounts for 0.08% of all visceral hernias and 8% of bowel obstruction secondary to internal hernias [1,2]. Historically FOWH was considered difficult to diagnose, often resulting in strangulated bowel contents at the time of presentation [3,4].…”