Cecal bascule herniation through the foramen of Winslow

Abstract

Bowel obstructions can have a variety of causes, including impacted feces, adhesions, volvulus, non-internal hernias, and in rare cases internal hernias. We report a 63-year-old woman who presented to the emergency department with severe abdominal pain, nausea, vomiting, and obstructive symptoms that had started 12 hours earlier. A computed tomographic scan of the abdomen and pelvis showed a right internal hernia with a cecal bascule traversing through the foramen of Winslow, concerning for a closed-loop obstruction. The patient underwent an exploratory laparotomy with cecal bascule reduction and cecopexy. Given the increased mortality risk if undiagnosed, it is important to remain aware of internal hernias. Patient outcomes are markedly improved with early diagnosis and surgical intervention.

Caecopexy as management for caecal volvulus: An evidence-based case report

“…No mortality, morbidity and recurrence after treatment for 34 days. 11 Williams, 2021 [ 15 ] Female, 63 years old Case report Caecopexy None None None 5 Diagnosis using a CT scan. No mortality, morbidity, and recurrence after follow-up for 6 months 12 Jeo, 2023 Male, 33 years old Case report Caecopexy None None None 5 Diagnosis using CT scan.…”

“…Nonoperative measures were successfully performed only in one in 26 patients with caecal bascule [ 3 ]. Caecopexy can also be worked on various characteristics of patients with caecum volvulus, for example, in patients with a history of roux-en-y gastric bypass [ 9 ], cholecystectomies [ 9 ], viable and non-viable caecum [ 4 ], without intestinal gangrene [ 8 ], with caecal bascule herniation through Winslow foramen [ 15 ].…”

“…Caecal volvulus patients with caecal bascule herniation through Winslow foramen are recommended to perform a right hemicolectomy to minimize recurrence even if the caecum is viable. However, there has not been a single case report reporting a hernia recurrence after the caecopexy procedure, so caecopexy can still be considered a main surgical option [ 15 ].…”

Cecal volvolus herniation through the Winslow Foramen: a case report and literature review of surgical management

“…and Williams et al. [ 12 , 13 ] report two cases of cecal bascule, where the Cecum folds on itself rather than twisting on its vascular axis and resulting in ischemia. The resection could be spared and a cecopexy was performed to reduce the gut mobility and prevent the recurrence of CV.…”