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Del Cerro Rodríguez D, González-Pola Yuncal S, Altamirano S, García Saavedra S, Gómez Tellado M. [A case of abdominal internal hernia through the foramen of Winslow in a pediatric emergency department]. An Sist Sanit Navar 2024; 47:e1068. [PMID: 38488072 PMCID: PMC10933693 DOI: 10.23938/assn.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/12/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024]
Abstract
Abdominal internal hernia is a rare cause of intestinal obstruction in pediatric emergency departments, being the herniation through the foramen of Winslow an exceptional entity (less than 0.5% of the herniae). We report the case of a 15-year-old adolescent male without previous surgical interventions who presented with abdominal pain and vomiting; computed tomography scans showed intestinal obstruction due to an internal hernia through the foramen of Winslow. To reduce the herniated ileum, the patient required surgical intervention with diagnostic laparoscopy, which, due to bad visualization, was changed to supraumbilical midline laparotomy. There was no need to resect the affected ileum as it appeared healthy. We did not perform a preventive technique to reduce the risk of recurrence. Postoperative pelvic collection was conservatively managed with antibiotics. The patient undergoes regular follow-up in the pediatric surgery department.
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Kamaleddine I, Popova M, Angles T, Neese M, Brinkmann B, Volmer E, Weber MA, Lamprecht G, Schafmayer C, Alwali A. Retroperitoneal cecal volvulus: a complication of a rare internal hernia - a case report. Ann Med Surg (Lond) 2024; 86:1647-1653. [PMID: 38463092 PMCID: PMC10923356 DOI: 10.1097/ms9.0000000000001540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/17/2023] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance The foramen of Winslow hernia (FWH) is a rare type of internal hernia. In one-third of cases, the cecum was found in the lesser sac. More rarely, the herniated cecum might be volvulated, which represents 1-1.5% of the causes of intestinal obstruction. Once diagnosed, surgical reduction and/or resection of the nonviable herniated bowel is crucial for a positive outcome. Case presentation The authors report a case of retroperitoneal cecal volvulus that complicated FWH in a patient with a history of laparoscopic cholecystectomy. Clinical discussion A delay in the diagnosis is associated with high morbidity and even higher mortality. Because of lacking a consensus, the treatment of FWH depends on the team's surgical experience. Conclusion Reporting this case will help us to keep in mind this differential diagnosis while treating patients in our daily practice.
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Affiliation(s)
- Imad Kamaleddine
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Magdalena Popova
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Theresa Angles
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Manuela Neese
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Beate Brinkmann
- Department of Medicine II, Division of Gastroenterology and Endocrinology
| | - Erik Volmer
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Georg Lamprecht
- Department of Medicine II, Division of Gastroenterology and Endocrinology
| | - Clemens Schafmayer
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Ahmed Alwali
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
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Williams AM, Pickell Z, Shen MR, Sangji N. Cecal bascule herniation through the foramen of Winslow. AUTOPSY AND CASE REPORTS 2021; 11:e2020236. [PMID: 34307210 PMCID: PMC8294840 DOI: 10.4322/acr.2020.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/01/2020] [Indexed: 12/22/2022] Open
Abstract
Bowel obstructions can have a variety of causes, including impacted feces, adhesions, volvulus, non-internal hernias, and in rare cases internal hernias. We report a 63-year-old woman who presented to the emergency department with severe abdominal pain, nausea, vomiting, and obstructive symptoms that had started 12 hours earlier. A computed tomographic scan of the abdomen and pelvis showed a right internal hernia with a cecal bascule traversing through the foramen of Winslow, concerning for a closed-loop obstruction. The patient underwent an exploratory laparotomy with cecal bascule reduction and cecopexy. Given the increased mortality risk if undiagnosed, it is important to remain aware of internal hernias. Patient outcomes are markedly improved with early diagnosis and surgical intervention.
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Affiliation(s)
- Aaron M Williams
- University of Michigan, Michigan Medicine, Department of Surgery, Ann Arbor, MI, USA
| | - Zachary Pickell
- University of Michigan, Michigan Medicine, Department of Surgery, Ann Arbor, MI, USA
| | - Mary R Shen
- University of Michigan, Michigan Medicine, Department of Surgery, Ann Arbor, MI, USA
| | - Naveen Sangji
- University of Michigan, Michigan Medicine, Department of Surgery, Ann Arbor, MI, USA
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Daher R, Montana L, Abdullah J, d'Alessandro A, Chouillard E. Laparoscopic management of foramen of Winslow incarcerated hernia. Surg Case Rep 2016; 2:9. [PMID: 26943685 PMCID: PMC4744601 DOI: 10.1186/s40792-016-0139-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/03/2016] [Indexed: 11/17/2022] Open
Abstract
Foramen of Winslow hernia (FWH) is a rare and often overlooked diagnosis with a high mortality rate. Widespread availability of cross-sectional imaging allows early diagnosis and prompt management. In this setting, before ischemia occurs, explorative laparoscopy would be the most suitable approach. Experience, however, remains sparse, and technical difficulties may be encountered. This is the case of a 38-year-old Caucasian woman who presented to the emergency department for a sudden epigastric pain. Physical exam was unremarkable, and routine blood tests were within normal range. An abdominal computed tomography (CT) scan confirmed the diagnosis of ileocaecal herniation through the foramen of Winslow. Under urgent laparoscopy, the caecum appeared viable but incarcerated in the lesser sac. Caecal puncture was the key to achieving atraumatic reduction of the hernia and bowel salvage.
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Affiliation(s)
- Ronald Daher
- Department of General and Minimally Invasive Surgery, Centre Hospitalier Intercommunal Poissy/Saint-Germain-En-Laye, 10, rue du Champ Gaillard, 78300, Poissy, France
| | - Laura Montana
- Department of General and Minimally Invasive Surgery, Centre Hospitalier Intercommunal Poissy/Saint-Germain-En-Laye, 10, rue du Champ Gaillard, 78300, Poissy, France
| | - Jarrah Abdullah
- Department of General and Minimally Invasive Surgery, Centre Hospitalier Intercommunal Poissy/Saint-Germain-En-Laye, 10, rue du Champ Gaillard, 78300, Poissy, France
| | - Antonio d'Alessandro
- Department of General and Minimally Invasive Surgery, Centre Hospitalier Intercommunal Poissy/Saint-Germain-En-Laye, 10, rue du Champ Gaillard, 78300, Poissy, France.
| | - Elie Chouillard
- Department of General and Minimally Invasive Surgery, Centre Hospitalier Intercommunal Poissy/Saint-Germain-En-Laye, 10, rue du Champ Gaillard, 78300, Poissy, France
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Makarawo T, Macedo FI, Jacobs MJ. Cecal bascule herniation into the lesser sac. World J Clin Cases 2014; 2:903-906. [PMID: 25516868 PMCID: PMC4266841 DOI: 10.12998/wjcc.v2.i12.903] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 10/15/2014] [Indexed: 02/05/2023] Open
Abstract
Cecal bascule is a rare cause of bowel obstruction in which a mobile cecum folds anteriorly and superiorly over the ascending colon. Herein, we present the first case of internal herniation of a cecal bascule into the lesser sac through the foramen of winslow, aiming at discussing radiological findings, differential diagnosis, and surgical management of this uncommon condition. A 75-year-old female presented to the emergency room with an 18-h history of sudden onset sharp, progressively worsening abdominal pain associated with vomiting. Physical exam revealed abdominal distention and epigastric tenderness while initial laboratory tests were unremarkable. Computed tomography of her abdomen and pelvis showed a loop of distended colon within lesser sac without signs of bowel ischemia or perforation. On exploratory laparotomy, a cecal bascule was found herniating into lesser sac via foramen of winslow. Upon reduction, the cecum appeared viable therefore a cecopexy was performed without bowel resection. Unlike cecal volvulus, cecal bascule consists of no axial rotation of the bowel with no mesenteric vascular compromise and therefore ischemia would only occur from intraluminal tension or extraluminal compression from the borders of foramen of winslow. The management of internal herniation of a cecal bascule is always surgical including anatomic resection or cecopexy.
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Chattopadhyay D, Wynne KS. Internal herniation of the anterior gastric wall through an attenuated Nissen Fundoplication wrap: an unusual complication and its laparoscopic management. Hernia 2010; 15:695-8. [PMID: 20694799 DOI: 10.1007/s10029-010-0711-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 07/11/2010] [Indexed: 01/11/2023]
Abstract
Laparoscopic Nissen fundoplication is the treatment of choice for medically refractive gastro-oesophageal reflux disease as it is considered safe, cost efficient and effective. Unusual variants of internal abdominal herniation, however, have been reported after the procedure. Here, we present a case of a 38-year-old woman who presented 3 months after a successful laparoscopic Nissen Rossetti fundoplication, with abdominal pain and persistent vomiting. Abdominal X-ray at the time of admission was normal but CT suggested internal herniation of the stomach. Laparoscopy confirmed internal herniation of the anterior wall of the stomach through an attenuated fundoplication wrap. We show that a prompt diagnosis of this complication, which we have not found reported previously in the English literature, can be achieved by CT, permitting an early laparoscopic intervention to preserve the viability of the obstructed segment of stomach.
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Affiliation(s)
- D Chattopadhyay
- Department of General Surgery, South Tyneside Hospital, South Shields NE34 0PL, UK
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Holder-Murray J, Statter MB, Liu D. Bowel Obstruction Secondary to Internal Hernia after Laparoscopic Nissen Fundoplication and Gastrostomy Tube Placement. Am Surg 2009. [DOI: 10.1177/000313480907501227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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