Foramen Hernia Research Articles

Successful early diagnosis and surgical treatment of congenital caval foramen hernia in an 8-month-old mixed breed cat

An 8-month-old neutered female domestic mixed breed cat was presented to Dr. L. Kriaučeliūnas Small Animal Clinic due to coughing that persisted for 2 weeks. Lateral and dorsoventral chest radiographs revealed an unusual dome-shaped soft tissue opacity mass that had contact with the cranial part of the diaphragm. Together with heart and abdominal ultrasound findings, we decided that one of the differential diagnoses was a diaphragmatic hernia. During the diagnostic celiotomy, a vertical 4 cm in length diaphragmatic deficit was visualized. Left medial and lateral liver lobes were herniated, yet healthy-looking. Adhesions between the liver lobes and the pericardium sac were visualized and dissected. The pericardium was sutured with simple interrupted suture pattern. A herniorrhaphy was performed suturing the diaphragm with the continuous suture pattern. Successful surgical treatment resulted in fully resolved clinical symptoms.

外科的に整復した先天性大静脈孔ヘルニアの犬の1例

外科的に整復した先天性大静脈孔ヘルニアの犬の1例

Reversed Bowel Rotation with Midgut Volvulus and Internal Hernia

Congenital intestinal malrotation is a group of intestinal rotational anomalies occurring during embryogenesis. Reversed rotation is considered the rarest type of malrotation and often presents with symptoms of bowel obstruction. We present a rare case of a 27-year-old woman who presented with acute abdomen. The patient’s preoperative computed tomography (CT) scan and operative findings confirmed reverse malrotation, internal hernia of foramen of Winslow, and midgut volvulus. The transverse colon, duodenum, small bowel, cecum, and appendix were abnormally located, with the presence of Ladd bands. The patient underwent an emergency laparotomy (Ladd procedure) with an uneventful postoperative recovery and an unremarkable follow-up CT scan of the abdomen. A review of the literature for intestinal reverse malrotation is also presented to provide an understanding of the expected clinical picture and imaging findings for this rare anomaly.

A Case of Winslow Foramen Hernia Caused by Postoperative Adhesion

A Case of Winslow Foramen Hernia Caused by Postoperative Adhesion

Radiographic and computed tomographic features of caval foramen hernias of the liver in 7 dogs: mimicking lung nodules.

This study describes the imaging features and characteristics of caval foramen hernias in 7 dogs diagnosed by computed tomography (CT). On lateral radiographs, 6 of 7 dogs showed dome-shaped, broad-based, caudal mediastinal lesions. CT findings included caudal vena cava (CVC) compression (n=7), right lateral (n=6) or medial (n=1) liver lobe involvement, hepatic vein dilation (n=5) and biliary tract involvement (n=1) with partial (n=6) or entire (n=1) liver lobe hernias. A caval foramen hernia should be part of the differential diagnosis when the aforementioned imaging features are detected. CT is considered as a useful tool for diagnosis and evaluation in dogs with a caval foramen hernia.

腹腔鏡下修復術を施行した食道裂孔ヘルニアとMorgagni孔ヘルニア併存の1例

腹腔鏡下修復術を施行した食道裂孔ヘルニアとMorgagni孔ヘルニア併存の1例

A Case of a Winslow Foramen Hernia Caused by Pregnancy and Birth

A Case of a Winslow Foramen Hernia Caused by Pregnancy and Birth

Index of Suspicion

ARTICLE| January 01 2013 Index of Suspicion Author DisclosureDrs Saini, Karmarkar, Rongkavilit, Bolton, Roth, English, and Ceri have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Pediatr Rev (2013) 34 (1): 41–46. https://doi.org/10.1542/pir.34.1.41 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Index of Suspicion. Pediatr Rev January 2013; 34 (1): 41–46. https://doi.org/10.1542/pir.34.1.41 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsPediatrics In ReviewPediatricsHospital PediatricsNeoReviewsAAP Grand RoundsAAP NewsAll AAP Sites Search Advanced Search Subjects: Letter from the President, Pediatric Drug Labeling Update, Pediatrician Wellness Topics: abdomen, abdominal ultrasonography, acute abdominal pain, cough, hernia of foramen of morgagni, congenital, pain, vomiting, intestinal obstruction, chest x-ray, ascariasis You do not currently have access to this content.

97歳にて発症したMorgagni孔ヘルニア嵌頓の1例

症例は97歳，男性．上腹部痛を主訴に当院救急外来を受診した．腹部単純CTにてMorgagni孔に嵌入する横行結腸と大網を認め，Morgagni孔ヘルニア嵌頓と診断した．疼痛は次第に増強し，ヘルニア内容の血流障害を否定できなかった．一方で超高齢，心筋梗塞・心不全の既往，抗血栓療法中などの高リスクから手術適応の判断に苦慮したが，御家族が手術を希望され緊急開腹となった．手術所見では嵌頓した横行結腸や大網は用手的に還納され，軽度の血流障害を認めるのみであり壊死や穿孔は認めなかった．ヘルニア門は3×3.5cmであり，ヘルニア嚢は処理せず縫合閉鎖のみを行い，短時間にて手術を終了した．術後肺炎を併発したが軽快し自宅退院となり，現在102歳にて存命である．1990年以降本邦で報告されている，超高齢者に発症したMorgagni孔ヘルニア症例において，自験例は13例目，最高齢，唯一の男性であった．

A case of Winslow Foramen Hernia Diagnosed Preoperatively with CT

A case of Winslow Foramen Hernia Diagnosed Preoperatively with CT

Transverse Colon Herniation Through the Foramen of Winslow Presenting With Unusual CT Findings

Bowel herniation through the foramen of Winslow is among the rarest of internal hernias, accounting for less than 0.8%. In its origin, a pivotal role is played by some anatomic variations, or anomalies such as the increased mobility of the right transverse colon, and maybe the exceedingly large bore of the foramen itself. The first case of hernia through the foramen of Winslow was reported by Blandin in 1834. Since then, no more that 200 new cases have been described. Diagnosis usually is established during surgery while treating a bowel obstruction. Only in an exceedingly small group of patients is diagnosis achieved preoperatively on the basis of radiological findings. We describe a preoperatively diagnosed case of transverse colon herniation through the foramen of Winslow, showing a portal vein narrowing and periportal lymphedema at computed tomography (CT). To the best of our knowledge, only a few cases of preoperative CT diagnosis of Winslow foramen hernia have been described in the past. None had the above-mentioned CT findings.

A Case of Femoral Hernia Associated with Obturator Foramen Hernia Diagnosed Preoperatively.

Obturator foramen hernia is a relatively rare disease and is likely to occur in aged, thin females. Herein we report a case of obturator foramen hernia associated by incarcerated femoral hernia. A 95-year-old woman was seen at the hospital because of nausea and vomiting. At admission, she was diagnosed with incarcerated femoral hernia due to swelling at the right lower area of the groin. Because an abdominal simple X ray demonstrated intestinal obstruction as well as Howship-Romberg sign was obtained, a pelvic CT was performed. The pelvic CT demonstrated right obturator hernia. At laparotomy, a large omentum was incarcerated at the right femoral ring while the small intestine 130cm proximal from the terminalileum showed Richter type hernia at the right obturator foramen. Operative procedures included: reposition of the large omentum and the ileum; resection of a part of the large omentum; and closure of the hilus of the hernia. With a recent progression in imaging procedures, clinical cases diagnosed as obturator foramen hernia preoperatively have been increasing. Aggrssive examination sincluding CT scan are useful in making preoperative diagnosis of the disease, especially not to overlook associated hernia which is difficult to be detected by palpation like in this case.

A CASE OF MORGAGNI' FORAMEN HERNIA DIAGNOSED PREOPERATIVELY

A case of Morgagni's foramen hernia involving only the greater omentum which was preoperativery diagnosed by angiography is reported. A 64-year-old woman was referred to the hospital with a suspicion of having a mediastinal tumor at a mass screening medical examination. Chest x-ray film revealed a fist-sized tumor shadow at a corner of diaphragm in the right heart. Chest CT visualized a tumor shadow of fat density adjacent to the right side of cardiac shadow behind the sternum. On sagittal plane of chest magnetic resonance imaging (MRI), a tumor shadow of fat density which was adjacent to the pericardium and anterior thoracic wall and communicated with the abdomen was confirmed. Morgagni's foramen hernia was suspected, but a possibility of mediastinal tumor could not be ruled out. So an angiography was performed and an omental branch of the right gastroepiploic artery along the tumor shadow was revealed. From these findings, the patient was diagnosed as having Morgagni's foramen hernia containing only the greater omentum and was operated on. At operation, the greater omentum was reduced by an abdominal approach, and the hernial openning was closed after the hernial sac was resected from the abdominal cavity. In the diagnosis of the disease, angiography is very valuable.

A CASE OF WINSLOW FORAMEN HERNIA INCARCERATED IN THE ISTHMUS OF BURSA OMENTALIS

Winslow foramen hernia is an extremely rare disease of all entoceles. We report our recent experience with a case of Winslow foramen hernia. A 25-year-old woman was admitted to the hospital because of upper abdominal pain on August 6, 1995, and was kept under close medical observasion. Two days later the abdominal pain was intensified. An emergency operation was carried out with a diagnosis of strangulated ileus 39 hours after the onset of the symptom. Upon laparotomy the center of the small intestine passed through the Winslow foramen and was incarcerated into the isthmus of bursa omentalis. By incising a part of the isthmus of bursa omentalis, the strangulation was relieved. Enterectomy was not necessary because the circulation of the small intestine was improved after reduction. In this case, we could not diagnose before the operatrion. Looking back this case retrospectively, we think that we should be able to diagnose before the operation if we entertained the possible presence of Winslow foramen hernia. Preoperative abdominal CT and ultrasonography that visualized the intestine passing through posterior side of the hepatoduodenal ligament strongly suggested this disease.

ADULT BOCHDALEK FORAMEN HERNIA WITH EXTRALOBER SEQUESTRATION-A CASE REPORT-

A 74-year-old woman was seen at the hospital by an ambulant car because of feeling of heaviness in the chest and dyspnea following flu like symptoms. There was no previous history of trauma, and she had deneyed to undergo any operation for diaphragmatic hernia that was pointed out at the age of 30. After admission, a chest X-ray film revealed a displacement of the mediastinum and a massive gastrointestinal gas image in the left thoracic cavity. A diagnosis of respiratory insufficiency due to diaphragmatic herina was made. CT visualized prolapse of the stomach, small intestine, spleen, and a part of the transverse colon, and atelectasis of the left lower lobe. An operation was electively performed under oblique thoracolaparotomic incision. A diaphragmatic defect was 70×50mm in size and placed dorsolateral to an esophageal hiatus, that was most likely a Bochdalek foramen hernia. The intraperitoneal organs could be easily restored without any adhesion, and no sac was observed. The diaphragm was enhanced by Marlex mesh after it was sutured and closed. When the thoracic cavity was observed, extralobar sequestration was detected just above the diaphragm and it was resected. An abnormal artery 10mm in diameter flowed into the sequestered lung from the aorta, and fine veins running along with the artery were also seen. During postoperative two days, assisted ventilation was performed for hypoventilation due to increased abdominal pressure, but thereafter, the patient recovered her health.

OUTCOMES OF ABDOMINAL SURGERY IN PATIENTS 90 YEARS AND OLDER

The outcomes of abdominal surgery in 11 patientss 90 years and older were evaluated. Two patients with incarcerated femoral hernia, 2 with incarcerated obturator foramen hernia, and one with perforation of the jejunum underwent intestinal resection, one of whom with obturator foramen hernia had additional procedures for cholecysto-choledocholithiasis and ovarian cyst. Simple closure was performed in a patient with perforated duodenal ulcer. Two patients with large-bowel cancer and one with jejunual cancer underwent curative intestinal resection with lymph node dissection, whereas colostomy for palliation was performed in 2 large-bowel cancer patients. Of these, seven (64%) patients underwent emergency operation. A general anesthesia was performed in 5 (45%) patients. Major complication occurred in one (9%) patient and postoperative death within 30 days was encountered in 2 (18%). Preoperative underlying diseases and abnormal laboratory parameters had no correlation with postoperative morbidity. However, patients with ASA (American society of anestheologists physical status classification) class III showed shorter survival than class II patients. In conclusion, it is suggested that such abdominal surgery as reported herein can be safely performed in patients even 90 years and older by selecting the method of anesthesia appropriate to individual cases and avoiding excessive surgical stress, and that long-term survival may be poorer for patients with higher ASA classification.

A CASE OF WINSLOW FORAMEN HERNIA

Entocele represents only about 1% of all causes for ileus, and Winslow foramen hernia which represents about 8% of all entoceles is extremely rare. This paper presents a recent experience with such a rare case of Winslow foramen hernia with a review of the literature. A 43-year-old man was seen at the hospital because of abdominal pain. Abdominal plain X-ray film revealed small bowel air forming air-fluid level at a high location of inside portion of the lesser curvature of the stomach. Ileus was suspected and the patient was emergently admitted to the hospital. Abdominal CT visualized a intestine-like shadow with thickened wall incarcerating into the omental bursa from the dilated Winslow foramen. The patient was diagnosed as strangulated hernia due to Winslow foramen hernia. An emergency operation was carried out. Upon operation the ileum by about 30cm incarcerated into the omental bursa from the Winslow foamen and strangulated at 1m distant from the terminal ileum. Reduction of the ileus improved vascular disturbance, and hence excision of the intestine did not demanded. It has been said that the disease presents difficulty in preoperative diagnosis, but in this case abdominal CT greatly contributed to early diagnosis and early treatment.

HERNIA OF THE FORAMEN MORGAGNI

Three cases of hernia of the foramen Morgagni that is often refered as a rare type among diaphragmatic hernias are reported and examined from preoperaitve diagnostic aspect. The patients were all females aged 12, 73, and 77 years who were detected from abnormal shadow in the chest radiogram. The hernia involved the greater omentum alone in 2 cases and a part of right lobe of the liver in one case. Morgagni's foramen hernia of which content includes the greater omentum or liver is difficult to be diagnosed before surgery, successful preoperative diagnosing rate being as low as 20%. In the three patients, preoperative CT scanning could successfully detected Morgani's foramen hernia. The CT scan is extremely valuable as preoperative diagnostic method, however, consecutive through scanning from the lower part of the thoracic cavity to the upper part of the abdorminal cavity is important.

Hernia of the Foramen of Winslow: Operation and Recovery

Hernia of the Foramen of Winslow: Operation and Recovery