Time Course of Herniation through the Foramen of Winslow Monitored by Computed Tomography—A Case Report—

Abstract

A 36-year-old Japanese man presented to the emergency department of our hospital with sudden epigastric pain after elaborate toilet cleaning. Initial computed tomography (CT) did not reveal any evidence suggesting the underlying cause of pain. However, his pain worsened, and contrast-enhanced CT performed 9 hours later revealed the small intestine had herniated into the omental bursa through a defect between the portal vein and the inferior vena cava, and we diagnosed herniation through the foramen of Winslow (HFW). Laparoscopic surgery was performed 21 hours after the onset of symptoms. The invaginated small intestine showed prominent congestion ; however, the color improved following reduction, which obviated the need for intestinal resection. He was discharged 9 days later following an uneventful recovery. HFW is a rare internal hernia ; however, it can be diagnosed preoperatively on CT. In most cases, decompression using an ileus tube is challenging, and we recommend that immediate surgery be performed as first-line treatment after diagnosis. In this case, we could follow the time course of the development of HFW on CT. We conclude that the patient's posture and elevated abdominal pressure (during toilet cleaning) contributed to the serious presentation in this case.