Gallbladder hernia into the foramen of Winslow: CT findings

Abstract

We present a case of gallbladder hernia into the foramen of Winslow. During the diagnosis of hernia, ultrasonography, computed tomography and intravenous computed tomography, cholangiography of the abdomen were performed. Ultrasonography detected gallstone, but did not provide sufficient information to diagnose gallbladder hernia. Computed tomography yielded the correct diagnosis. At laparoscopic cholecystectomy, the diagnosis was confirmed.

Foramen of Winslow hernia: an open approach

“…Typical findings are: (a) the presence of mesenteric adipose tissues and intestinal loops behind the hepatic pedicle, (b) abnormal localization of the cecum, (c) gas and/or fluid in the lesser sac with a "bird's beak" pointing towards the epiploic foramen, (d) evidence of bowel obstruction in the lesser sac, associated with mesenteric vessels stretching anteriorly to the inferior vena cava and posteriorly to the portal vein, and (e) displacement of the stomach anteriorly and laterally. 12 Operative management is the treatment of choice. It is not advisable to wait for spontaneous reduction of the hernia as this may lead to intestinal ischemia.…”

Selective Nonoperative Management of Foramen of Winslow Hernias

“…The epiploic foramen of Winslow is the only natural anatomical opening with the possibility of intra-abdominal hernia. [1][2][3] The foramen serves as a communication between the lesser and greater coeloma. 1,3 The foramens anatomic boundaries are posterior to the hepatoduodenal ligament and anterior to the inferior vena cava, inferior to the caudate lobe of the liver, and superior to the duodenum.…”

“…Also mentioned is a failure of fusion of the right colonic mesentery leading to a mobile cecum and ascending colon. [1][2][3] Acquired factors include increased intra-abdominal pressure during pregnancy or a postprandial period, obstructive distal colonic lesions, and postoperative periods after laparoscopic cholecystectomy or fundoplication. 2 Traditionally, abdominal radiographs enhanced with oral and rectal contrast were used to identify the defect.…”

“…CT scans can demonstrate the stretching of the mesenteric vessels and involved bowel anterior to the inferior vena cava and posterior to the portal vein. [1][2][3] A ''narrow portal vein sign'' has also been described as a clue to the diagnosis.…”

Laparoscopic surgery in a patient with foramen of Winslow hernia due to large uterine fibroids: a case report and literature review

“…The incidence of FWH is rare, constituting approximately 8% of internal hernia cases [2]. Although the exact mechanism underlying the pathogenesis of FWH remains unclear, recent reports have shown that increase in the foramen of Winslow diameter (> 3 cm), visceral mobility, and intra-abdominal pressure predisposes patients to FWH [1][2][3][4][5]. Excessive viscera mobility may be due to long bowel mesentery, persistence of the ascending mesocolon, bowel malrotations, and large right hepatic lobe [3].…”