Abstract
A63-year-old man visited our hospital complaining of severe upper abdominal pain and was admitted with adiagnosis of intestinal obstruction. Abdominal X-rayfilms showed several air-fluid levels located on the Th12 and L1 vertebrae, and interruption of small-bowel gas on the right side of the L1 vertebra. An enema examination with water-soluble contrast medium revealed adistal ileum crossing the transverse colon and tapering on the right side of the L1 vertebra. With the preoperative diagnosis of intestinal herniation through the foramen of Winslow, an emergency laparotomy was performed. Operative findings showed that a loop of distal ileum was incarcerated through the foramen of Wnslow into the lesser sac. The gangrenous ileal segment approximately 70cm in length wasresected. Only 16 patients with hernia through the foramen of Winslow have been reported in Japan, and in these patients it was difficult to make apreoperative diagnosis. In this case, we could make the diagnosis preoperatively from abdominal X-ray films and the valuable findings of an enema examination.
