Hernia through the foramen of Winslow

A case of hernia through the foramen of Winslow diagnosed preoperatively is reported. Although the preoperative diagnosis is difficult to make because of the nonspecific symptoms presented and the rarity of the disease, careful evaluation of the plain abdominal X-ray and barium enema study gave the clue in the present case. Review of the literature including those from Japan revealed 115 cases up to 1976, of which diagnosis was established preoperatively in 11 cases.     

Intestinal obstruction caused by a foramen of Winslow hernia

Hernias occurring through the foramen of Winslow are extremely rare (accounting for only 8% of all internal hernias and 0.08% of all hernias) and are seldom diagnosed preoperatively. A delay in treatment is responsible for high mortality rates of around 36% to 49%. Successful management requires prompt diagnosis and surgical treatment.     

Foramen of Winslow hernia

Two cases of caecal herniation through the foramen of Winslow are presented. The diagnosis was made at laparotomy, but could have been suspected from the clinical features and plain abdominal X-rays. Early operative intervention is the key to avoiding strangulation and the high mortality associated with this uncommon internal hernia.     

OBSTRUCTIVE JAUNDICE DUE TO FORAMEN OF WINSLOW HERNIA A CASE REPORT

An unusual case of obstructive jaundice due to foramen of Winslow hernia is presented. The hernia reentered into the general peritoneal cavity through the lesser omentum and this appeared to be important in the pathogenesis of jaundice in this patient. Accurate pre-operative diagnosis of this uncommon condition remains difficult despite the advent of modern imaging techniques such as computerized tomography. Optimal outcome demands a high index of suspicion and early surgical intervention, together with operative measures to prevent future recurrence. The pathoanatomy of caecal herniation through the foramen of Winslow is also discussed.     

Hernia of cecum and ascending colon through the foramen of Winslow

INTRODUCTIONInternal hernias through the foramen of Winslow are rare events and constitute 8% of internal hernias but only 0.1% of all abdominal hernias.PRESENTATION OF CASEA 62-year-old man presented with upper abdominal pain, distention and vomiting, and was shown on CT scan to have the right colon and cecum herniating into the lesser sac through the foramen of Winslow. This diagnosis was confirmed at laparotomy as well as a midgut volvulus and right hemicolectomy was performed because of ischemic changes of the cecum.DISCUSSIONSix developmental abnormalities may result in internal herniation of bowel contents in the abdomen: (i) abnormal retroperitoneal fixation of the mesentery resulting in anomalous positioning of the intestine; (ii) incomplete mesenteric surfaces with the presence of abnormal opening through which the intestine herniates, (iii) abnormally large internal foramina or fossae (e.g. foramen of Winslow); (iv) abnormally long small-bowel mesentery; (v) an elongated right hepatic lobe thought to guide bowel into the foramen of Winslow, and (vi) persistence of the ascending mesocolon allowing marked mobility of the right colon.CONCLUSIONWe believe that hypermobile cecum was responsible for the internal herniation through the foramen of Winslow and that this served as the lead point allowing for the midgut volvulus. There is no consensus on the surgical management of internal hernias through the Foramen of Winslow when the herniated contents are grossly viable. The literature in this regard is scarce and surgical decision making is based on surgeon preference and the viability of the herniated intraabdominal contents.     

Transverse colon herniation through the foramen of winslow presenting with unusual CT findings

Bowel herniation through the foramen of Winslow is among the rarest of internal hernias, accounting for less than 0.8%. In its origin, a pivotal role is played by some anatomic variations, or anomalies such as the increased mobility of the right transverse colon, and maybe the exceedingly large bore of the foramen itself. The first case of hernia through the foramen of Winslow was reported by Blandin in 1834. Since then, no more that 200 new cases have been described. Diagnosis usually is established during surgery while treating a bowel obstruction. Only in an exceedingly small group of patients is diagnosis achieved preoperatively on the basis of radiological findings. We describe a preoperatively diagnosed case of transverse colon herniation through the foramen of Winslow, showing a portal vein narrowing and periportal lymphedema at computed tomography (CT). To the best of our knowledge, only a few cases of preoperative CT diagnosis of Winslow foramen hernia have been described in the past. None had the above-mentioned CT findings.     

Laparoscopic repair of a Morgagni hernia

Laparoscopic repair of a diaphragmatic hernia through the right sternocostal foramen of Morgagni in an obese 42-year-old man is described. The indications for surgery were symptoms of strain-induced dyspnea and tightness in the chest. The technique was carried out by incorporating a marlex mesh into the defect and fixing it in place with hernia staples. The patient had an immediate recovery after repair of the hernia and has remained free of recurrence or complaints 9 months after surgery.     

Hernia Through the Foramen of Winslow

This is a report of a hernia through the foramen of Winslow in which the right half of the colon was herniated. It was gangrenous and perforated. Following hemicolectomy the patient recovered.     

Internal hernia. Report of nine cases

Summary Internal abdominal hernias are rare and develop when one or more viscera protrude through an intraperitoneal orifice while remaining within the peritoneal cavity. This orifice may be normal (Winslow's foramen) or paranormal (peritoneal fossae); these hernias possess a sac and are true hernias. Protrusion may be through a pathologic hole, without a sac, realizing an internal prolapse or procidentia. The clinical diagnosis is always difficult and leads to an urgent operation for intestinal obstruction. The treatment is often simple and the results are generally excellent.     

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

(Received for publication on May 6, 1999; accepted on Jan. 7, 2000)     

Internal hernia traversing the lesser sac

Congenital internal hernias are a rare cause of small bowel obstruction in adults and often present with complications. A high index of suspicion, occasionally aided by appropriate radiological imaging, may lead to early surgical intervention and reduce morbidity and mortality. A 25‐year‐old man presented with colicky abdominal pain and minimal signs on abdominal examination. Computed tomography showed features of a small bowel obstruction and prompted surgery. This revealed an internal hernia traversing the lesser sac through defects in both the gastrocolic ligament and lesser omentum. A gangrenous segment of small bowel incarcerated in the lesser omentum was resected and the patient made a full recovery. The published reports relating to lesser sac hernias are reviewed and features that may lead to early diagnosis identified.      

一孔法腹腔镜小儿腹股沟斜疝高位结扎术的临床应用

目的探讨腹腔镜治疗小儿腹股沟斜疝新方法。方法采用一孔法腹腔镜手术治疗小儿腹股沟斜疝102例,其中右侧70例,左侧20例,双侧12例。单侧斜疝中有9例存在对侧隐性疝,均在腹腔镜下行内环口高位缝扎术。结果手术时间单侧疝平均14分钟,双侧疝26分钟。术后平均2天出院。皮肤切口无须缝线。无并发症。病人随访6～26个月,平均15个月,未见复发。结论一孔法腹腔镜下斜疝疝囊内环口高位缝扎术安全有效、创伤小、操作简便。     

FORAMEN OF WINSLOW HERNIA

Two cases of caecal herniation through the foramen of winslow are presented. The diagnosis was made at laparotomy, but could have been suspected from the clinical features and plain abdominal x-rays. Early operative intervention is the key to avoiding strangulation and the high mortality associated with this uncommon internal hernia.     

Internal hernia and volvulus of the small bowel following liver transplantation

Internal herniation with volvulus of the small intestine is an uncommon, but potentially fatal, complication after liver transplantation. We present here four cases in which the herniation occurred around the Roux-en-Y loop used for the biliary reconstruction. One patient died due to intestinal and liver allograft necrosis; another lost almost the entire small intestine and has since undergone successful intestinal transplantation. Two patients survived following surgery that involved reduction of the hernia and closure of the mesenteric defect. Clinical diagnostic implications emphasize early diagnosis and appropriate operative intervention. Received: 2 May 1996 Received after revision: 7 October 1996 Accepted: 28 October 1996