Internal herniation of the cecum through the foramen of Winslow—a case report

Abstract

Foramen of Winslow hernias are a rare, but dangerous form of internal hernia that can present in individuals with signs and symptoms of bowel obstruction. This case report details operative management of a cecal herniation through the foramen of Winslow in an elderly male with no prior history of intra-abdominal surgery. The patient presented with worsening abdominal pain, nausea, vomiting and obstipation. Due to the clinical picture of a complete bowel obstruction and subsequent imaging findings, an urgent abdominal exploration was performed. During the procedure, the cecum was found to be ischemic and strangulated in the lesser sac, herniated through the foramen of Winslow. Following operative reduction and right hemicolectomy, it was decided to close the foramen of Winslow to prevent recurrence and future complications. The patient had an uncomplicated postoperative course with resolution of symptoms.

A Twisted Cecum: Herniation and Volvulus of the Cecum Through the Epiploic Foramen

“…Symptom onset can be acute or subacute, typically accompanied by signs and symptoms of intestinal obstruction [4]. Diagnosis is made based on physical exam and imaging, and definitive care requires surgery [4]. Here, we present a case with subacute onset with progression to small bowel obstruction due to an internal herniation of the distal small bowel, cecum, ascending colon, and hepatic flexure through the epiploic foramen into the lesser sac with associated cecal volvulus.…”

“…An internal hernia is a projection of abdominal viscera through a peritoneal or mesenteric defect or window in the abdominal or pelvic cavity [1]. Internal hernias of the bowel through the epiploic foramen or foramen of Winslow, also known by the eponym Blandin's hernia, account for approximately 8% of internal hernias [2][3][4]. The estimated overall incidence of cecal herniation through the foramen of Winslow is reported to be 0.02% [5].…”

“…Both open and laparoscopic methods of reduction are described, with the vast majority of cases performed using laparotomy. Less than 10% of internal hernias through the epiploic foramen are diagnosed preoperatively [4]. Often, definitive care is delayed because the full extent of the herniation and any potential strangulation of the bowel is not recognized until the patient is in the operating room (OR); consequently, these cases have a mortality of up to 50% [4].…”

“…Less than 10% of internal hernias through the epiploic foramen are diagnosed preoperatively [4]. Often, definitive care is delayed because the full extent of the herniation and any potential strangulation of the bowel is not recognized until the patient is in the operating room (OR); consequently, these cases have a mortality of up to 50% [4]. With prompt CT and early surgical intervention, mortality can be reduced to 5% [4].…”

“…Symptom onset can be acute or subacute, typically accompanied by signs and symptoms of intestinal obstruction [4]. Diagnosis is made based on physical exam and imaging, and definitive care requires surgery [4].…”