Caecal volvulus in a foramen of Winslow hernia

Abstract

Caecal herniation through the foramen of Winslow is an uncommon presentation of internal hernia with an estimated overall incidence of 0.02%. Even rarer still is a caecal volvulus strangulated in the lesser sac, a surgical emergency seldom described in the literature. A woman in her 70s presented with a 1-day history of acute-onset right upper quadrant and epigastric pain associated with nausea and vomiting. Prompt CT imaging revealed caecal volvulus within a foramen of Winslow hernia. The diagnosis was confirmed by laparotomy. A right hemicolectomy was performed and the foraminal defect was closed. We identified eight case reports of this rare entity published within the last 30 years. Our patient was managed in a similar manner and recovered without complication, providing further guidance for the operative management of caecal volvulus in the foramen of Winslow.

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

“…In the case of Carpenter et al. [ 2 ], the bowel could not be reduced and right hemicolectomy was directly performed.…”

“…Even rarer are internal hernias, also accounting for only 1% of Bowel Obstructions. The Foramen of Winslow Hernia (FWH) accounts for 8% of internal Hernias and the cecum is the herniated organ only in one-third of the cases [ 2 ]. Both clinical presentations are associated with a mortality rates up to 30 and 49%, respectively if not promptly recognized and treated [ 3 , 4 ].…”

Internal hernia through the foramen of Winslow: a rare cause of intestinal obstruction with imminent ischaemia of the caecum

“…Additionally, certain authors proposed the excision of excessively long and mobile intestinal segments 15 21. The decision to perform resection, often motivated by the intent to prevent recurrence, remains a subject of controversy 5 6 11 12. Notably, this debate is also reflected in case reports featuring open procedures, where some advocate pexy of the bowel segment while others opt for resection 16…”

“…Since then, around 200 cases have been reported5 (figure 1). The first description of an FWH with caecum as the hernia content was in 1970, and since then, seven other cases have been published 6. With the following case report, we would like to raise awareness for these cases and discuss diagnostic and therapeutic considerations.…”

A Twisted Cecum: Herniation and Volvulus of the Cecum Through the Epiploic Foramen

“…Internal hernias of the bowel through the epiploic foramen or foramen of Winslow, also known by the eponym Blandin's hernia, account for approximately 8% of internal hernias [2][3][4]. The estimated overall incidence of cecal herniation through the foramen of Winslow is reported to be 0.02% [5]. A current PubMed search of case reports using keywords "cecal volvulus" and "foramen of Winslow" returned nine published case reports within the last 10 years.…”