Abstract
A 31-year-old man was admitted to the hospital with a 1-day history of upper abdominal pain and vomiting. On the second day of hospitalization, the abdominal pain and distension became more severe. Furthermore, Blumberg's sign and muscular defence subsequently developed. Abdominal CT scan showed obvious dilation of the small intestine, ascites, and herniation of the fan-shaped mesentery and vascular structures between the portal vein and inferior vena cava. An emergency laparotomy was performed for a suspected strangulation ileus due to herniation through the foramen of Winslow. Operative findings showed that a 20 cm portion of the small intestine about 170 cm distal to the ligament of Treitz had herniated through the foramen of Winslow into the omental bursa. Manual reduction of the hernia was performed via the Kocher maneuver. Intestinal resection was needed due to the presence of intestinal necrosis. Herniation through the foramen of Winslow often shows characteristic findings on abdominal CT images. CT examination enabled the precise preoperative diagnosis of where the hernia orifice was. As reported in the Japanese literature, the small intestinal resection rate has been 20^30% in case of small intestinal herniation through the foramen of Winslow. It is possible to perform laparoscopic reduction without performing intestinal resection, if the bowel can be decompressed using the long tube approach.
