Laparoscopic management of foramen of Winslow incarcerated hernia

Cecal internal hernia through Winslow's hiatus

BACKGROUND

Hernia through Winslow's hiatus, known as Blandin's hernia, a rare but potentially life-threatening condition, represents a diagnostic and therapeutic challenge. This case report describes a successful laparoscopic approach to a cecum hernia through the foramen of Winslow in a 63-year-old female.

CASE PRESENTATION

The patient presented with 24 hours of abdominal pain and nausea. Abdominal CT scan revealed a herniated cecum and terminal ileum compressing the gastric chamber and portal vein, leading to periportal edema. Laparoscopic right colectomy was performed after successful colon content evacuation via the greater gastric curvature to facilitate reduction. This was done to aid in reduction, as there were indications of non-viability in the right colon. The procedure unfolded without complications. The patient developed postoperative abdominal collections requiring percutaneous drainage but recovered well and was discharged within two weeks.

CONCLUSION

This case highlights the value of laparoscopy in managing foramen of Winslow hernias, offering minimally invasive benefits. Early diagnosis through imaging tools like CT is crucial for prompt surgical intervention and preventing complications like intestinal ischemia or perforation.

[A case of abdominal internal hernia through the foramen of Winslow in a pediatric emergency department]

Abdominal internal hernia is a rare cause of intestinal obstruction in pediatric emergency departments, being the herniation through the foramen of Winslow an exceptional entity (less than 0.5% of the herniae). We report the case of a 15-year-old adolescent male without previous surgical interventions who presented with abdominal pain and vomiting; computed tomography scans showed intestinal obstruction due to an internal hernia through the foramen of Winslow. To reduce the herniated ileum, the patient required surgical intervention with diagnostic laparoscopy, which, due to bad visualization, was changed to supraumbilical midline laparotomy. There was no need to resect the affected ileum as it appeared healthy. We did not perform a preventive technique to reduce the risk of recurrence. Postoperative pelvic collection was conservatively managed with antibiotics. The patient undergoes regular follow-up in the pediatric surgery department.

Retroperitoneal cecal volvulus: a complication of a rare internal hernia - a case report

Introduction and importance

The foramen of Winslow hernia (FWH) is a rare type of internal hernia. In one-third of cases, the cecum was found in the lesser sac. More rarely, the herniated cecum might be volvulated, which represents 1-1.5% of the causes of intestinal obstruction. Once diagnosed, surgical reduction and/or resection of the nonviable herniated bowel is crucial for a positive outcome.

Case presentation

The authors report a case of retroperitoneal cecal volvulus that complicated FWH in a patient with a history of laparoscopic cholecystectomy.

Clinical discussion

A delay in the diagnosis is associated with high morbidity and even higher mortality. Because of lacking a consensus, the treatment of FWH depends on the team's surgical experience.

Conclusion

Reporting this case will help us to keep in mind this differential diagnosis while treating patients in our daily practice.

[Strangulated hernia of the foramen of Winslow complicated by acute colonic obstruction]

Internal hernias, in particular, hernia of the foramen of Winslow, are rare and occur in typical sites. Laparotomy is common in these cases while laparoscopic surgery is rarely used in such urgent cases. However, modern diagnosis and treatment including computed tomography and laparoscopy allowing minimally invasive interventions are not an exception for patients with hernia of the foramen of Winslow. This approach is effective for this problem and prevents adverse outcomes of disease.

Internal hernia through the foramen of Winslow: a rare cause of intestinal obstruction with imminent ischaemia of the caecum

An internal hernia through the foramen of Winslow represents a rare surgical pathology. This report describes a case with incipient caecal ischaemia and discusses current diagnostic and therapeutic approaches. A patient in his early 60s presented at the emergency department with abdominal pain and last bowel movement three days prior. A CT scan of the abdomen suggested an internal hernia into the lesser sac. Intraoperatively, the suspected diagnosis could be confirmed laparoscopically with a twisted mobile caecum herniating through the foramen of Winslow. Due to a suspected ischaemia and laparoscopic frustrated reduction, a right open hemicolectomy was performed. The hernia gap was closed. The postoperative course was uneventful. Despite the rarity of internal hernias in patients without prior abdominal surgery, surgeons should be aware of this entity. The diagnosis can be difficult and sometimes only established intraoperatively. Open surgery is usually required. If the gap is clearly identified, the recommendations tend towards its closure.

An extremely unusual condition that leads to intestinal obstruction: Foramen Winslow hernia

It is known that foramen Winslow hernia (FWH) is a very rare disease and difficult to diagnose because there are no specific examina-tion findings. Patients usually present to the emergency department with an intestinal obstruction. Delay in diagnosis may cause isch-emia and perforation of the intestinal loop. Difficulties in early diagnosis increase the probability of this condition resulting in mortality. A 41-year-old male patient was admitted to the emergency department with colic abdominal pain lasting for 2 days. The patient was hospitalized for further examination and treatment. Due to the improvement in his clinical state, the patient was discharged; however, 2 days later, he was readmitted to the emergency department with an inability to pass stool or flatus, nausea, and vomiting, as well as abdominal pain. After laboratory tests and imaging methods were applied to the patient, surgery was decided upon. In the laparoscopic examination, it was observed that the small bowel loop herniated into the foramen Winslow (FW) at 220 cm proximally from the ileocecal junction. Herniated bowel loops were reduced. The open FW was not intervened in, and the operation was terminated. Due to their rarity, FWHs are less likely to be considered a preliminary diagnosis in individuals who present to the emergency department with intestinal obstruction. FWH may be considered in patients with congenital anomalies and without previous abdominal surgery. The best imaging technique for diagnosis is contrast-enhanced abdominal computed tomography (CT), and it is critical to recognize bowel loops in the omentum minus on CT.

Simultaneous Winslow and Petersen’s Hernias after a Roux-en-Y Gastric Bypass Causing Bowel Obstruction: Laparoscopic Management and Review of the Literature

Internal hernias after Roux-en-Y gastric bypass are one of the most common complications in bariatric surgery leading to hospital readmissions with or without surgery. Due to the insidious and non-specific clinical presentation combined with difficult radiological identification, internal hernias remain a diagnostic and therapeutic challenge. Delay in diagnosis and treatment can lead to severe morbidity and mortality. We report the case of a patient presenting an unusual intestinal obstruction due to two simultaneous and distinct internals hernias affecting the Petersen’s defect and the foramen of Winslow 4 years after a laparoscopic gastric bypass. A 41-year-old female patient with a history of robotic laparoscopic Roux-en-Y gastric bypass presented with proximal small bowel obstruction symptoms and epigastric pain. Computed tomography showed two simultaneous internal hernias, one affecting the Petersen’s defect and the other affecting the foramen of Winslow with an incarcerated transverse colon. We performed an explorative laparoscopy to reduce both hernias and, after an assessment of bowel viability by indocyanine green angiography, we closed both defects with interrupted non-absorbable sutures to prevent recurrence. The follow-up of more than 1 year has been uneventful. In the cases of obstruction and hospital admission after gastric bypass, we suggest that patients undergo a computed tomography directly after the initial examination. Internal hernia diagnosis is often delicate and requires surgical exploration since bowel strangulation can lead to dramatic outcomes. The operation can be safely done laparoscopically, and all internal hernia defects should be repaired with non-absorbable sutures.

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

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.

Laparoscopic surgery in a patient with foramen of Winslow hernia due to large uterine fibroids: a case report and literature review

BACKGROUND

Foramen of Winslow hernia (FWH) is a rare but emergent condition caused by an increase in the foramen diameter, visceral mobility, and intra-abdominal pressure. To the best of our knowledge, this is the first study to report a case of FWH secondary to large uterine fibroids that was successfully treated with laparoscopic surgery.

CASE PRESENTATION

A 52-year-old woman with large uterine fibroids was diagnosed with FWH. Because of the absence of signs of bowel ischemia and peritonitis, we performed an elective laparoscopic surgery through a 5-port system after bowel decompression using a long intestinal tube. Although foramen of Winslow closure was not performed, her postoperative course was uneventful.

CONCLUSIONS

Laparoscopic surgery for FWH is considered an extremely effective surgical treatment option because of its safety and efficacy in performing delicate procedures (such as adhesiolysis) with a good magnified field of view.

Cecal bascule herniation through the foramen of Winslow

Bowel obstructions can have a variety of causes, including impacted feces, adhesions, volvulus, non-internal hernias, and in rare cases internal hernias. We report a 63-year-old woman who presented to the emergency department with severe abdominal pain, nausea, vomiting, and obstructive symptoms that had started 12 hours earlier. A computed tomographic scan of the abdomen and pelvis showed a right internal hernia with a cecal bascule traversing through the foramen of Winslow, concerning for a closed-loop obstruction. The patient underwent an exploratory laparotomy with cecal bascule reduction and cecopexy. Given the increased mortality risk if undiagnosed, it is important to remain aware of internal hernias. Patient outcomes are markedly improved with early diagnosis and surgical intervention.

Less invasive treatment for broad ligament hernia: A case report

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We experienced a case of a broad ligament hernia of the uterus, which is relatively rare among the cases of internal hernia that were treated by less invasive laparoscopic surgery.

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If intestinal ischemia can be ruled out, a less invasive laparoscopic surgery may be performed after intestinal decompression.

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Making a diagnosis of broad ligament hernia of the uterus by CT can lead to easier and safer laparoscopic surgery and shorter operation time.

Introduction

Among diseases that cause small bowel obstruction, internal hernia may result in severe outcomes. Therefore, emergency laparotomy has been often performed, but it may be invasive. We experienced a case of a broad ligament hernia of the uterus, which is relatively rare among the cases of internal hernia that were treated by less invasive laparoscopic surgery.

Case presentation

A 71-year-old woman came to our hospital because of abdominal pain and vomiting. Abdominal computed tomography (CT) revealed a broad ligament hernia of the uterus without intestinal ischemia. Intestinal decompression was done by inserting an ileus tube (® Long Intestinal Tube, CLINY), followed by elective laparoscopic surgery.

Discussion

If intestinal ischemia can be ruled out, a less invasive laparoscopic surgery may be performed after intestinal decompression. Further, by detecting the cause of internal hernia, more safe and smooth surgery can be performed. These findings highlighted the importance of accurate CT diagnosis.

Conclusion

In order to perform laparoscopic surgery for internal hernia, evaluation of the presence or absence of intestinal ischemia and detection of the cause of obstruction by preoperative abdominal CT are important.

Internal herniation of the caecum and the ascending colon through the foramen of Winslow

We are reporting a case of internal herniation of the bowel through the foramen of Winslow. This is a very rare condition that prompts an urgent operative intervention due to its potential fatal complications, as it is usually accompanied by bowel strangulation and ischemia. Due to the vague clinical picture, the diagnosis only reached using imaging techniques such as computed tomography or as a surgical surprise during the operation. Key aspects of surgical interventions are hernia reduction, bowel resection in case of non-viable ischemic bowel and the highly debatable recurrence prevention maneouvres.

Internal herniation through the falciform ligament of the liver: a case report

Background: An internal abdominal hernia is defined as the protrusion of a viscus through a mesenteric or peritoneal aperture within the peritoneal cavity. A less common type of internal herniation is a small bowel herniation through a defect in the falciform ligament of the liver. This defect can be congenital or iatrogenic after penetration of the falciform ligament with a trocar during laparoscopic surgery. Methods: We present a case report illustrating an internal herniation through an iatrogenic defect in the falciform ligament of the liver. Results: A 78-year-old man comes to the emergency department with severe abdominal pain for several hours. Laparoscopic exploration shows a small bowel herniation through an iatrogenic defect of the falciform ligament after laparoscopic cholecystectomy. Reduction of the internal herniation is performed. Due to subsequently small bowel necrosis, a small bowel resection with primary anastomosis has to be performed too. Conclusion: Small bowel herniation through an iatrogenic defect in the falciform ligament is very rare. However, it can lead to severe complications such as small bowel necrosis. To prevent internal herniation, we strongly suggest immediate repair or division of the falciform ligament when an iatrogenic defect is created during laparoscopic procedures.

Foramen of Winslow Hernia: a Review of the Literature Highlighting the Role of Laparoscopy

Foramen of Winslow hernia (FWH) is an extremely rare entity accounting for up to 8% of internal hernias and 0.08% of all hernias. Only 150 cases of FWH have been described in the literature to date with a peak incidence between the third and sixth decades of life. Three main mechanisms seem to be implicated in the FWH pathogenesis: (a) excessive viscera mobility, (b) abnormal enlargement of the foramen of Winslow, and (c) changes in the intra-abdominal pressure. The presence of an abnormally long bowel, enlargement of the right liver lobe or cholecystectomy, a "wandering cecum," and defects of the gastrohepatic ligaments are some reported predisposing factors. Timely diagnosis through computed tomography facilitates the appropriate treatment before complications are evident. Although open repair has been mostly utilized, recently laparoscopic approach seems to gain ground due to the encouraging preliminary results. To date, the debate continues as to whether prophylactic measures to prevent recurrence of the FWH need to be undertaken: closure of the foramen, fixation of the highly mobilized viscera, or both.

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

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.

Herniation of the hepatic flexure through the foramen of Winslow, and a review of literature describing the minimally invasive technique

Foramen of Winslow hernias is a rare and challenging diagnosis as signs and symptoms are usually non-specific. CT imaging has become the method of choice in diagnosing such conditions preoperatively. Traditionally managed via laparotomy, there has been an increase in the use of the minimally invasive technique in recent times, though experience remains sparse. This is a case of a 73-year-old woman with hepatic flexure herniation through the foramen of Winslow who was managed by the traditional laparotomy approach. A review of the literature was performed to learn key techniques in the use of laparoscopy to manage future cases.

Internal hernia of caecum through the foramen of Winslow

Internal hernias through the foramen of Winslow are very rare. An 80-year-old female patient presented with epigastric and right upper quadrant pain associated with abdominal distention, nausea and vomiting for 1 day. A CT scan showed an internal hernia with terminal ileum and caecum identified within the lesser sac. The diagnosis was confirmed by laparotomy. A right hemicolectomy was performed to prevent further recurrence. We reviewed case reports with the same presentation by searching the Pubmed database using the keywords: 'foramen Winslow hernia, cecum'. We identified 23 publications. Our review extracted the following information: presentation, anatomical findings, pathological causes and surgical management. Misdiagnosis was common due to the limitations of plain abdominal X-rays. Abdominal CT scan is now the preferred radiological study and is more effective in establishing a diagnosis. Surgical treatment options varied. Right hemicolectomy has emerged as the preferred procedure to decrease the rate of recurrence.

Case of ileal herniation through the foramen of Winslow diagnosed preoperatively by CT and treated with laparoscopic surgery

A previously healthy 35-year-old man visited the emergency room complaining of epigastric pain and vomiting. The pain was sudden in onset. His blood tests were within normal limits except for a mild neutrophilia of 14 300/μL. Enhanced abdominal CT scan showed the small intestine dilated into the space between the portal vein and inferior vena cava from the foramen of Winslow. Under the diagnosis of herniation through the foramen of Winslow (HFW), we performed emergency laparoscopic surgery. Laparoscopy revealed an internal herniation of the dilated small intestine through the foramen of Winslow. Because the herniated small intestine was viable, intestinal resection was unnecessary. We released the incarceration under laparoscopy. HFW is very rare and often overlooked, but abdominal CT examination enabled a precise preoperative diagnosis because of characteristic findings. We should consider the possibility of HFW in patients with internal herniation of unknown origin. Laparoscopic surgery for HFW is effective.

Spontaneous reduction of small bowel herniation through the foramen of Winslow: importance of a timely approach

We present the case of young female patient presenting with acute onset abdominal pain. Abdominopelvic CT revealed herniation through the foramen of Winslow. The patient was transferred to our hospital and underwent laparoscopic exploration. Though spontaneous reduction was detected, segmental resection of the impacted small bowel was inevitable due to ischemic change. Our case suggests that reducing the time until surgery is very important to lower the probability of bowel resection in case of small bowel herniation through the foramen of Winslow.

Internal Herniation Through Foramen of Winslow: A Diagnosis Not to Be Missed

INTRODUCTION

Hernias through the foramen of Winslow are extremely rare, accounting for 0.1% of all abdominal hernias. Delayed diagnosis is often observed, resulting in bowel strangulation and high mortality.

METHOD

We present a case of a patient with strangulated ileum herniated through the foramen of Winslow. Recent literature review was undertaken on "PubMed" as a search platform using the keywords "foramen of Winslow" and "hernia".

CASE SUMMARY

A 66-year-old man presented acutely with severe epigastric pain and vomiting. An emergency computed tomography scan revealed a loop of ileum in the lesser sac. At emergency laparotomy, a herniated loop of ileum that had become strangulated at its entry to the lesser sac via the foramen of Winslow was confirmed. The loop of ileum was reduced but was nonviable, which had to be resected with a primary anastomosis. The patient's postoperative recovery was uneventful.

CONCLUSION

Herniation through the foramen of Winslow is a difficult diagnosis and must not be missed. Early cross-sectional imaging and surgical intervention are advised in order to reduce morbidity.

Herniation of the colon through the foramen of Winslow-A case report

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Herniation is rare and diagnostic delay increases mortality and morbidity.

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Patients present with nonspecific acute abdominal pain.

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Computed tomography helps early diagnosis and could thereby prevent bowel ischemia.

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Herniation can be reversed laparoscopically without bowel resection in case of early diagnosis.

Introduction

Herniation of the bowel through the foramen of Winslow is a rare condition presenting with acute abdominal pain. Diagnostic delay often results in high morbidity and mortality.

Case presentation

A patient presented with right sided acute abdominal pain. Computed tomography showed herniation of the ascending colon through the foramen of Winslow which could be reversed laparoscopically without the need for bowel resection. There were no postoperative complications and no recurrences have occurred to date.

Discussion

Bowel herniation through the foramen of Winslow is very rare, comprising only 8% of all internal herniations. Historically, the majority of cases was diagnosed intra-operatively and bowel resection was necessary because of ischemia. With the introduction of computed tomography, the diagnosis can be made earlier, possibly resulting in a lower morbidity and mortality rate.

Conclusion

Herniation through the foramen of Winslow is a rare condition. Patients will present with sudden onset abdominal pain. Early imaging helps to recognize the diagnosis and could prevent bowel ischemia.