Herniation of the gall-bladder through the foramen of Winslow

Abstract

both posterior tibial arteries were felt and the right dorsalis pedis vessel had become palpable for the first time, but at that date the left dorsalis pedis remained undetectable. T h e blood-pressure, five months after the operation, in the right arm was 146/82 mm., in the left arm 126/100 mm., and in the right tibial vessels, as ascertained by palpation of the dorsalis pedis artery, 82 systolic. On screening the heart the left ventricle was still prominent, but cleared the spine in the left anterior oblique position. T h e aortic knuckle was placed very high in the chest, as seen in the right semi-oblique position. I n the anteroposterior view the aorta barely cleared the left spinal border. It would, therefore, appear that the result of the operation had been to improve very definitely the circulation through the aorta, for the systolic pressure of the right arm has been reduced, the collateral circulation has nearly disappeared, and the arterial supply to the right foot is clearly better.A further point worthy of note is that previous to operation a definite diastolic murmur was audible to the left of the sternum, and this was in 1945 taken to indicate an aortic valve incompetence. When a patent ductus arteriosus was found at operation, this murmur was naturally ascribed to this. Following operation, at which the distal end of the patent ductus arteriosus was removed, together with the coarctation and part of the vestigial left subclavian artery, it was assumed that the diastolic murmur would disappear. I n fact, the murmur has remained and still has the high-pitched quality characteristic of aortic regurgitation. This introduces a complication from the medical point of view, and it is conceivable that the explanation is to be found in the fact that the present case may be an example of coarctation of the aorta combined with a minor degree of subaortic stenosis and aortic insufficiency, a triad of abnormalities which is well recognized. A further point in favour of this is the persistence of the systolic apical murmur conducted to the aortic base. CONCLUSIONSA case of coarctation of the aorta with great difference between the blood-pressures of the arm is recorded. This difference was due to a vestigial condition of the left subclavian artery. A successful anastomosis was performed between the proximal and distal ends of the aorta after excision of the coarctation.Five months later the patient was in normal, active health, with an improving circulation to the lower limbs, and the abnormal psychological behaviour present before the operation appeared to have improved.

A surgical case report of an epiploic hernia — A mobile right colon herniating through the foramen of Winslow

“…With <0.1 % of abdominal hernias and 8 % of internal hernias, the Epiploic Hernia through the Foramen of Winslow is a rare occurrence [ 1 ]. There have been case reports of small bowel as the content of the hernia with lesser occurrences of caecum, ascending colon, transverse colon [ 5 ], gall bladder [ 6 ], Omentum, or Meckel's diverticulum [ 7 ]. A caecal herniation through the Foramen of Winslow is reported only at an incidence of 0.02 % [ 8 ].…”

Intestinal obstruction due to small bowel herniation through foramen of Winslow: a case report

“…The small bowel is most often involved, followed by the cecum and right colon and then the transverse colon [2]. Peculiar cases of herniated Meckel's diverticulum and gallbladder have also been reported [4,5]. Postulated predisposing factors for this condition include atrophic greater omentum, short transverse mesocolon, long mesentery of the small intestine, and abnormalities of intestinal rotation and a large foramen of Winslow [6].…”

Herniation of the colon through the foramen of Winslow—A case report

“…As mentioned earlier, most cases describe a herniation of small bowel loops (63%), the coecum and ascending colon (30%) or the transverse colon (7%) [1] , while there are cases describing herniation of the gall bladder [3] , a small bowel diverticulum [5] or a Meckel’s diverticulum [6] . This compares well to our current literature overview, showing herniation of mostly small bowel loops (67%) although often combined with herniation of the caecum or ascending colon (63%).…”

“…Most cases describe a herniation of a small bowel loop (63%), the caecum and ascending colon (30%) or the transverse colon (7%) [1] . In addition, cases have been reported of herniation of the gall bladder [3] , [4] , a small bowel diverticulum [5] or a Meckel’s diverticulum [6] . The incidence of herniation through the foramen of Winslow is higher in men (ratio 2.5:1), with a peak incidence between 20 and 60 years of age [7] .…”