Gallbladder herniation into the lesser sac through the foramen of Winslow: report of a case

Abstract

We report a case of gallbladder hernia into the lesser sac through the foramen of Winslow. The patient was a 90-year-old woman, admitted to hospital with obstructive jaundice. Computed tomography (CT) showed a left-deviated and remarkably enlarged gallbladder dragging the liver, and a dilated intrahepatic bile duct. The deviated gallbladder was thought to compress the common bile duct, causing the obstruction. Laparoscopic examination revealed gallbladder herniation into the lesser sac without a floating gallbladder; thus, we performed laparoscopic cholecystectomy. Herniation of the gallbladder is the rarest of all internal hernias and most reported cases have involved a floating gallbladder. The case we report here is therefore considered especially unusual.

Case report and operative management of gallbladder herniation

“…This also tends to occurs in females [ 12 ]. This demographic pattern also noted in related conditions such as gallbladder torsion [ 13 ] and internal gallbladder herniation [ 14 ]. As there may also be weakening of the anterior abdominal wall with age, other hernias (such as incisional hernias as observed in this reported case) may also be present.…”

Case of ileal herniation through the foramen of Winslow diagnosed preoperatively by CT and treated with laparoscopic surgery

“…The terminal ileum, cecum, and ascending colon are involved in about 25%–30% of cases. Other viscera such as the transverse colon, gallbladder, and omentum are occasionally involved . Anatomical risk factors for HFW include a long small bowel mesentry, a mobile cecum and ascending colon, an elongated right hepatic lobe, a large foramen of Winslow, a defect of the gastrohepatic ligament, and incomplete intestinal rotations or malrotation .…”

“…Therefore, the key to diagnosis relies on prompt radiological findings, especially CT scans, because of characteristic findings. Classical CT scan findings are as follows: (i) mesenteric fat and vessels anterior to the inferior vena cava and posterior to the hepatoduodenal ligament; (ii) gas and/or fluid collection in the lesser sac with a “bird's beak” pointing toward the foramen of Winslow; (iii) the presence of a dilated small intestine posterior to the lesser omentum and compressing the stomach; (iv) two or more bowel loops in the subhepatic spaces; and (v) absence of the ascending colon in the right iliac fossa (if the ascending colon and cecum are involved) . So we should consider HFW in patients with internal herniation of unknown origin for precise and early diagnosis.…”

Strangulated gallbladder caused by a tip of the omentum attached to the abdominal wall: a case report

“…Of these, torsion or volvulus of the gallbladder may be the most common cause of strangulation [1, 9]. According to previous reports, other conditions causing strangulation include herniation into the foramen Winslow [4–6], incisional hernia [7, 8] and strangulation associated with the omentum [2, 3]. …”