A Rare Case of Internal Hernia of Partial Volvulus Right Colon through Foramen of Winslow & Its Management by Laparoscopic Approach

Abstract

Introduction: Foramen of Winslow hernias is a rare and critical form of internal hernia that can present in individuals with signs and symptoms of bowel obstruction. This case report entails the operative management of a right-side colon herniation through the foramen of Winslow in an elderly female with a previous history of Hysterectomy. The patient presented with worsening abdominal pain, nausea, and multiple episodes of vomiting. Delay in diagnosis often results in higher morbidity and mortality. Case Presentation: A 46 years old female, presented with acute upper abdominal pain, constipation, and loss of appetite for 24 hrs. Computed tomography showed foramen of Winslow hernia with partial volvulus right colon as content with incomplete rotation of gut which was managed laparoscopically without the need for bowel resection. The patient recovered well with no postoperative complications and no immediate technical failure of repair confirmed by a cross-sectional study. The patient is doing well on follow-up. Discussion: Herniation of the bowel through the foramen of Winslow is very rare, comprising only 8% of all internal herniations. Historically, the majority of cases were diagnosed intra-operatively during laparotomy. Bowel resection was often done in cases of ischemia. In recent times, early diagnosis & increasing expertise in minimal access surgery that is resulting in a lower morbidity and mortality rate along with other added benefits of minimal access surgery. Conclusion: Herniation contents through the foramen of Winslow is a rare condition. Patients will present with sudden onset abdominal pain. Early imaging helps to recognise the diagnosis and could prevent bowel ischemia & its management with minimal access surgery leads to early recovery, shorter hospital stay, less pain & early return to work.