Abstract
An 82-year-old woman was admitted to the hospital because of abdominal pain and vomiting. There were slight tenderness in the abdomen and accelerated intestinal murmur. Simple abdominal x-ray examination revealed gaseous distention of the small intestine which extended to the right upper abdomen over the transverse colon partly and was seen at the hight of from the 12th thoracic vertebra to 1st lumber vertebra. On abdominal CT scan, the dilated intestine was situated dorsal to the stomach and ventral to the pancreas; cord which might be mesenteric vessel in fatty tissue ran upward on the right side of the duodenum and transversely ran dorsally to the liver and hepatoduodenal mesentery; and the continuity to the dilated intestine was confirmed. A hernia through the foramen of Winslow was diagnosed. At laparotomy, a part of the ileum about 30cm in length 200cm distant from the terminal ileum incarcerated in the omental bursa through foramen of Winslow; and the small intestine strongly adhered to duodenal flexure. Operative procedures included a repair of the incarcerated intestine and an excision of the small intestine including the adhered portion, and the foramen of Winslow which opened up to two fingers was not sutured for reduction. Postoperative course was uneventful. The disease lacks in characteristic symptoms and simple abdominal x-ray examination and CT are useful for preoperative diagnosis. Favorable prognosis can be expected for the disease by early diagnosis and early treatment.
