A case of herniation through the foramen of winslow diagnosed on multidetector-row ct (mdct)

Abstract

An 18-year-old woman developed vomiting and abdominal pain. On contrast enhanced MDCT, horizontal sections in the area between the inferior vena cava and the portal vein showed a dilated small intestine. Coronal sections of MDCT more clearly visualized the mesentery of the small intestine strangulated through the foramen of Winslow and the incarceration of the small intestine in the omental bursa. A foramen of Winslow hernia was diagnosed ; an emergent operation was performed. After the manual reduction, it was found that the small intestine which had become incarcerated in the omental bursa via the foramen of Winslow already had ischemic change. Therefore, about 100 cm of the ischemic intestine was resected. No abnormal opening of the foramen of Winslow was noted. In a young person with an ileus and no history of laparotomy, we should consider the possibility of an internal hernia including a foramen of Winslow hernia. As for diagnosis, MDCT is very useful since it can produce multidirectional, fine, and accurate images.