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Zeidan Z, Aburrous M, Dhumane P, Gopalswamy S, Arumugam P. Caecal Volvulus in a Foramen of Winslow Hernia Masquerading as Biliary Colic. Cureus 2024; 16:e66523. [PMID: 39246951 PMCID: PMC11380923 DOI: 10.7759/cureus.66523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2024] [Indexed: 09/10/2024] Open
Abstract
Internal hernias account for a minority of cases of intestinal obstruction. Within this group, internal hernias through the foramen of Winslow (FW) are an even rarer subcategory with a paucity of cases reported in the literature. We present a case of a 48-year-old female presenting with right upper quadrant pain akin to biliary colic with sonographic evidence of cholelithiasis. Her symptoms swiftly worsened, and she re-presented with symptoms of bowel obstruction. She was subsequently found to have a caecal volvulus herniating through the FW on computed tomography (CT). She underwent an emergency laparotomy to reduce the hernia and prevent further recurrence, which highlighted the importance of a comprehensive history and the increasing role of cross-sectional imaging in emergency surgery.
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Affiliation(s)
- Ziad Zeidan
- Department of Emergency Abdominal Surgery, Royal Cornwall Hospital Trust, Truro, GBR
| | - Mohamed Aburrous
- Department of Emergency Abdominal Surgery, Royal Cornwall Hospital Trust, Truro, GBR
| | - Parag Dhumane
- Department of Emergency Abdominal Surgery, Royal Cornwall Hospital Trust, Truro, GBR
| | - Sivakumar Gopalswamy
- Department of Emergency Abdominal Surgery, Royal Cornwall Hospital Trust, Truro, GBR
| | - Ponnandai Arumugam
- Department of Emergency Abdominal Surgery, Royal Cornwall Hospital Trust, Truro, GBR
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Gramellini M, Solimene F, Menz M, Hinterleitner L, Breitenstein S, Kambakamba P. Cecal volvolus herniation through the Winslow Foramen: a case report and literature review of surgical management. J Surg Case Rep 2024; 2024:rjae325. [PMID: 38803838 PMCID: PMC11129660 DOI: 10.1093/jscr/rjae325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
Both cecal volvolus and Winslow hernia are rare clinical presentations accounting for 1-1.5 and 0.08% of bowel obstructions. The combination of the two phenomena has been described so far in 13 case reports. Our patient underwent laparotomy with lesser Sac opening, manual hernia reduction, right hemicolectomy and partial Foramen closure with two simple stitches of PDS 4.0. Due to the scarcity of literature guidelines are not available, the intraoperative state of the tissues and the likelihood of a hernia recurrence play a decisive role in surgical management.
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Affiliation(s)
- Marco Gramellini
- Department of Surgery, Kantonsspital Winterthur, Brauerstrasse 15, Postfach, Winterthur 8401, Switzerland
| | - Folco Solimene
- Department of Surgery, Kantonsspital Winterthur, Brauerstrasse 15, Postfach, Winterthur 8401, Switzerland
| | - Moritz Menz
- Department of Surgery, Kantonsspital Winterthur, Brauerstrasse 15, Postfach, Winterthur 8401, Switzerland
| | - Lorenz Hinterleitner
- Medical University of Vienna, MedUni Vienna, Spitalgasse 23, Vienna 1090, Austria
| | - Stefan Breitenstein
- Department of Surgery, Kantonsspital Winterthur, Brauerstrasse 15, Postfach, Winterthur 8401, Switzerland
| | - Patryk Kambakamba
- Department of Surgery, Kantonsspital Winterthur, Brauerstrasse 15, Postfach, Winterthur 8401, Switzerland
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Kamaleddine I, Popova M, Angles T, Neese M, Brinkmann B, Volmer E, Weber MA, Lamprecht G, Schafmayer C, Alwali A. Retroperitoneal cecal volvulus: a complication of a rare internal hernia - a case report. Ann Med Surg (Lond) 2024; 86:1647-1653. [PMID: 38463092 PMCID: PMC10923356 DOI: 10.1097/ms9.0000000000001540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/17/2023] [Indexed: 03/12/2024] Open
Abstract
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.
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Affiliation(s)
- Imad Kamaleddine
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Magdalena Popova
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Theresa Angles
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Manuela Neese
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Beate Brinkmann
- Department of Medicine II, Division of Gastroenterology and Endocrinology
| | - Erik Volmer
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Georg Lamprecht
- Department of Medicine II, Division of Gastroenterology and Endocrinology
| | - Clemens Schafmayer
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Ahmed Alwali
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
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Jain S, Nessa A, Gandhi M, Ganesh R. A surgical case report of an epiploic hernia - A mobile right colon herniating through the foramen of Winslow. Int J Surg Case Rep 2024; 115:109312. [PMID: 38280345 PMCID: PMC10839949 DOI: 10.1016/j.ijscr.2024.109312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION An Epiploic Hernia is an extremely rare type of abdominal hernia with <0.1 % incidence where the bowel or other intra-abdominal contents herniate through the Foramen of Winslow. A case of an Epiploic hernia in a middle-aged female is presented here. PRESENTATION OF CASE A woman in her 60s was admitted to a tertiary level hospital with severe right sided intermittent upper abdominal pain associated with nausea, bloating and constipation. The symptoms were thought to be due to biliary colic and managed conservatively. Since the symptoms persisted and a computed tomography scan of abdomen was organized. CT scan showed that the caecum was in the upper left quadrant. A laparoscopy was performed and demonstrated that her right colon was mobile herniating through the Foramen of Winslow into the lesser sac. The hernia was reduced, and the bowel was viable. The patient was discharged with no complications. DISCUSSION There have been case reports of small bowel as the content of the hernia with lesser occurrences of caecum, ascending colon, transverse colon, gall bladder, omentum, or Meckel's diverticulum. A caecal herniation through the Foramen of Winslow is reported only with an incidence of 0.02 %. <10 % of these Epiploic hernias are diagnosed preoperatively making it a potentially life-threatening condition if not treated promptly due to high risk of bowel strangulation and mortality of up to 50 %. CONCLUSION A high index of suspicion is needed for the diagnosis of this internal hernia and radiological investigation is fundamental in making this diagnosis for allowing prompt surgical treatment.
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Affiliation(s)
- Shubham Jain
- Department of General Surgery, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen AB25 2ZN, United Kingdom
| | - Ashrafun Nessa
- Department of General Surgery, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen AB25 2ZN, United Kingdom; School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill Rd, Aberdeen AB25 2ZD, United Kingdom.
| | - Mark Gandhi
- Department of Radiology, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen AB25 2ZN, United Kingdom.
| | - Radhakrishnan Ganesh
- Department of General Surgery, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen AB25 2ZN, United Kingdom.
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Notz-Heusler L, Burla L, Steinauer A, Misteli H. Internal hernia through the foramen of Winslow: a rare cause of intestinal obstruction with imminent ischaemia of the caecum. BMJ Case Rep 2023; 16:e257281. [PMID: 37940197 PMCID: PMC10632806 DOI: 10.1136/bcr-2023-257281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
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.
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Affiliation(s)
| | - Laurin Burla
- Department of Surgery, Hospital Uster, Uster, Switzerland
| | | | - Heidi Misteli
- Department of Surgery, Hospital Uster, Uster, Switzerland
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Chandhrasekhar D, Droger A, Baatz M, Chapuis T, Fox-McClary DJ. A Twisted Cecum: Herniation and Volvulus of the Cecum Through the Epiploic Foramen. Cureus 2022; 14:e27754. [PMID: 36106284 PMCID: PMC9445405 DOI: 10.7759/cureus.27754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022] Open
Abstract
Herniation of the cecum, terminal ileum, and ascending colon through the epiploic foramen is an uncommon presentation of an internal hernia. An 82-year-old female presented with a small bowel obstruction; Computed Tomography (CT) imaging showed a herniation of the terminal ileum, cecum, and ascending colon through the foramen of Winslow into the lesser sac, with cecal volvulus. Prompt surgical treatment included laparotomy and reduction of the hernia, followed by an extended right hemicolectomy with primary anastomosis and functional closure of the epiploic foramen. This report reviews the natural history and management of this rare pathology.
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