Acute intestinal ischaemia due to a foramen of Winslow hernia

Excerpt

A 57-year-old woman presented to the emergency department with a 1-day history of abdominal pain in the epigastric area, which had been associated with nausea. Laboratory test results were normal. Abdominal computed tomography (CT) findings were initially interpreted as normal. After 10 h, the patient developed epigastric guarding and a distended abdomen. A second interpretation of the abdominal CT findings revealed an internal hernia with an incarcerated loop behind the hepatic pedicle (Fig. 1a, b). Emergency exploratory laparoscopy confirmed the imaging findings. Laparotomy revealed internal herniation of the small intestine through the foramen of Winslow. After hernia reduction, multiple patchy areas of intestinal necrosis were observed (Fig. 1c) and 20 cm of ischaemic small intestine was resected (Fig. 1d). The patient was hospitalised for 4 days without complications. Her diet was restarted on the first postoperative day, because intestinal transit was restored. At the 5-month follow-up visit, she was asymptomatic and exhibited no evidence of recurrence.

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