Herniation through the foramen of Winslow: a laparoscopic approach

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.

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.

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 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.

Laparoscopic management of cecum and ascending colon hernia through the foramen of Winslow

Herniation of gastrointestinal structures through the foramen of Winslow is rare, with patients presenting with nonspecific symptoms. We describe a 47-year-old woman who presented with generalized, intermittent, colicky abdominal pain for a duration of 4 days. An abdominal computed tomography scan revealed findings consistent with herniation of the ileocecal junction through the foramen of Winslow. Laparoscopic assisted internal hernia reduction with ileocecal resection and side-to-side ileocolic anastomosis were done. The cecum and terminal ileum were resected due to signs of ischemia. Her postoperative was uneventful, and she was discharged in the second postoperative day. She did not show any signs or symptoms suggestive of complications or recurrence during her follow-up.

Caecal herniation through the foramen of Winslow

Internal hernia is the protrusion of an abdominal viscus through the peritoneum or mesentery into a compartment within the abdominal cavity. We present a case of internal herniation through the foramen of Winslow that was identified by CT imaging. It was treated with reduction at laparotomy and subsequent right hemicolectomy.

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

•

Herniation is rare and diagnostic delay increases mortality and morbidity.

•

Patients present with nonspecific acute abdominal pain.

•

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

•

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.

Laparoscopic management of foramen of Winslow incarcerated hernia

Foramen of Winslow hernia (FWH) is a rare and often overlooked diagnosis with a high mortality rate. Widespread availability of cross-sectional imaging allows early diagnosis and prompt management. In this setting, before ischemia occurs, explorative laparoscopy would be the most suitable approach. Experience, however, remains sparse, and technical difficulties may be encountered. This is the case of a 38-year-old Caucasian woman who presented to the emergency department for a sudden epigastric pain. Physical exam was unremarkable, and routine blood tests were within normal range. An abdominal computed tomography (CT) scan confirmed the diagnosis of ileocaecal herniation through the foramen of Winslow. Under urgent laparoscopy, the caecum appeared viable but incarcerated in the lesser sac. Caecal puncture was the key to achieving atraumatic reduction of the hernia and bowel salvage.

Foramen of Winslow hernia: a minimally invasive approach

Hernias through the foramen of Winslow comprise 8 % of all internal hernias and the majority contain incarcerated bowel. Clinical signs are often non-specific and delay in diagnosis associated with a mortality rate that approaches 50 %. Management is urgent surgical reduction with bowel decompression and resection of devitalized bowel. A foramen of Winslow hernia (FWH) has traditionally been managed via an exploratory laparotomy incision and the vast majority of cases describe an open approach. We describe a minimally invasive approach to the management of an incarcerated FWH requiring decompression and bowel resection.

Internal hernia through the foramen of Winslow: the "narrowed portal vein" sign on abdominal CT

We report a case of ileal internal hernia through the foramen of Winslow into the lesser sac. Preoperative computed tomography (CT) demonstrated that the herniated ileum, which showed a closed-loop obstruction, was located behind the portal vein, and the vein was subsequently compressed and narrowed by the herniated ileum. We found that similar cases in the literature of Winslow's foramen hernias that caused portal vein compression; however, portal vein narrowing has not been described as a characteristic CT finding. The narrowed portal vein sign could be useful in diagnosing the hernia through the foramen of Winslow.

Caecal herniation through the foramen of Winslow: a rare cause of bowel obstruction

Internal herniation through the foramen of Winslow is a rare cause of abdominal hernia. We describe a case in which caecal herniation through the foramen of Winslow was diagnosed using various imaging modalities, including computed tomography and managed operatively through hernia identification, caecal reduction and foramen closure. The literature is subsequently reviewed to highlight previous similar episodes and identify the optimal modalities for pre-operative diagnosis and describe the most appropriate intra-operative management.

Correct preoperative diagnosis of herniation through the Foramen of Winslow: two case reports

We report two cases of one of the most infrequent types of internal abdominal hernias, i.e. incarcerated herniation through the Foramen of Winslow, with emphasis on appropriate preoperative radiological diagnosis using multidetector row computed tomography (MDCT) in both cases, and their successful surgical treatment.