Hernia through the Foramen of Winslow, Hernia Traversing the Lesser Sac and Allied Conditions

Abstract

A review of the general features is given based on a study of 62 cases from the literature; a further case showing previously undescribed clinical and radiological features is reported. The cases are subdivided according to hernial contents and the X-ray appearances for each type are given. When, as is common, there is intestine in the sac, the stomach is displaced forwards and to the left by a circumscribed collection of gas which projects above the lesser curvature. Incarcerated small intestine shows as multiple fluid levels within the limits of the sac; if barium is given, bunched and dilated bowel is seen confined as if in a bag on the left side, and a loop may be seen crossing over the duodenum to enter the gas-filled area. Stretching and great dilatation of the duodenum is a very striking feature. In colonic hernia a single fluid level is seen in the plain film and the duodenum is not stretched. Oral barium studies are not advised in this type. The less common varieties are described and the differential diagnosis is discussed. The distinction from hernia traversing the lesser sac is indicated and a possible case is described briefly.