2017 Volume 53 Issue 7 Pages 1302-1306
Internal herniation through the foramen of Winslow (HFW) is extremely rare and is commonly diagnosed at the time of surgery, as clinical findings are nonspecific. There has been no written report about a laparoscopic approach to HFW in a pediatric population, although several reports have recently addressed the usefulness of such an approach in adults. We report the case of a 13-year-old female patient who was preoperatively diagnosed as having HFW on the basis of computed tomography (CT) findings and who successfully underwent laparoscopic repair of HFW. The child was referred to our hospital after presenting to a different clinic with sudden-onset upper-right abdominal pain. We diagnosed her as having HFW because a CT scan with intravenous contrast showed a distended small intestine protruding into the omental bursa through the foramen of Winslow. An urgent laparoscopic exploration was performed approximately 12 hours after the onset of symptoms. Reduction of the herniated bowel was achieved laparoscopically with gentle traction. The reduced intestine appeared viable, so no resection was needed. At the end of surgery, the hernial defect obliterated. The patient recovered well with an uneventful postoperative course and was discharged. Prompt diagnosis and early exploration may lead to less invasive management of HFW.
