Lesser sac hernia

Lesser sac hernia through the gastrocolic ligament: CT diagnosis

“…The stomach is usually displaced anteriorly and laterally [13]. Enema study may reveal compression and blockage of the transverse colon as in our case [7,13].…”

“…The characteristic radiological appearances of the lesser sac hernia are a distended collection of bowel loops in the upper abdomen, fluid levels in the region of the lesser sac, and signs of mechanical bowel obstruction [10,11,13]. The stomach is usually displaced anteriorly and laterally [13].…”

Strangulated Foramen of Winslow Hernia

“…13], Making a preoperative diagnosis of hernia through the foramen of Winslow as a cause of intestinal obstruction is normally very difficult and, according to the literature, has been achieved in only a few instances [1][2][3], In his report. Stewart [4] described the possible radiographic findings which may be consistent with a lesser sac hernia. They are as follows: (1) Distended intestines crowded together in the upper abdomen, with a loss of mobility, as if in a bag; (2) gas-fluid levels in the region of the lesser sac; (3) a rounded gas accumulation in the epigastrium, apart from the gas shadow of the stomach; (4) displace ment of the stomach to the left; (5) compression and deformity of the gastric contour, corresponding to a lesser sac mass; (6) signs of intestinal obstruction.…”

“…Based on the site of entry. Stewart [4] classified these hernias into four types, namely, hernias through (1) the greater omentum; (2) the lesser omentum; (3) the foramen of Winslow, and (4) the transverse mesocolon. Apart from transomental hernias from which only 57 cases have been described until 1995 [5], hernias through the foramen of Winslow are distinct rarities; with our 2 patients the num ber of cases published in the world literature since the original description by Blandin in 1823 [1] is brought up to a total of 164 [1][2][3].…”

“…Other authors state that further con trast studies may add in establishing the correct diagnosis [10,12]. Data are unsupportive and despite all suspicions the diagnosis is usually made at the time of laparotomy [1][2][3][4][5][6][7][8][9][10][11][12][13]. In cases of obvious intestinal obstruction, at tempts at establishing the correct diagnosis may have del eterious consequences, especially in the elderly popula tion where any delay in prompt laparotomy may lead to life-threatening intraabdominal sepsis.…”