Foramen of Winslow hernia: an open approach

Abstract

Foramen of Winslow hernia (FWH) are considered rare even among other internal hernias. It was first described in 1834 and historically had a mortality rate of close to 50%. With modern advancement and availability of cross-sectional imaging, this number has improved dramatically to 5%. Operative management is required for all patients which can be performed with either an open or laparoscopic approach. Preventative measures for recurrence remain controversial as no case of recurrence has been reported to date. We present a case study of a 62 years old woman who presented to the emergency department with severe epigastric pain and a CT scan confirming an FWH. She underwent urgent laparotomy and the hernia was easily reducible without need of intestinal resection. We opted to fixate the right colon and close the foramen of Winslow to prevent future recurrence. She recovered from her surgery well and was discharged home without any complications.

Caecal herniation through the foramen of Winslow with spontaneous reduction

“…Once the contents are reduced, further measures have been described to prevent recurrence. These include closure of the FoW, resection of redundant bowel, or caecopexy of an excessively mobile colon 3,5–7 . Closure of the FoW is achieved by suture or omental patch, however, carries the risk of injury to the portal vein and bile duct.…”