A Case of Herniation through the Foramen of Winslow Diagnosed by Multidetector Row Computed Tomography

Abstract

A 35-year-old man developed sudden and severe abdominal pain and vomiting. Multidetector row computed tomography showed multiple gas-filled loops in the lesser sac posterior to the liver hilum and anterior to the inferior vena cava, and revealed intestinal obstruction due to herniation through the foramen of Winslow. We attempted placing a long intestinal tube in expectation of spontaneous hernia reduction. However, the treatment was ineffective, and we performed emergent laparotomy. The ileum was invaginated through the foramen of Winslow, and we reduced it manually. As the ileum had progressed to ischemia and necrosis, we performed intestinal resection and closed the foramen of Winslow. Surgery is considered as definitive and standard therapy and is clearly superior to preservative therapy with a long intestinal tube. Recent reports suggest that laparoscopic surgery can be performed for this condition. However, emergent surgery should be carefully considered on an individual basis, with emphasis on safety in this benign disorder.