A 52 y.o. presents with abd pain and the CT shown. What does this represent?

A hint is shown below

This patient had a hernia in the foramen of Winslow. (the hint was Winslow’s Homer’s  “Breezing Up” )This is similar radiographically to a cecal volvulus. Often, it can only be diagnosed at surgery.  Typically it contains small bowel only in 67% of the cases but may also contain cecum( as in this case) and less commonly contains transverse colon, gallbladder or omentum.   It was named after the anatomist Jacob B Winslow, working in Paris  who published a treatise on anatomy in 1732.  Foramen of Winslow hernias are rare and comprise only   0.08% of all hernias. Even more rare is a report of such a hernia occurring after sneezing. 

Often repair of these hernias consists of removal of the herniated object without closure of the sac because of the risk of adhesions to vessels. If the bowel cannot be reduced, the surgeon can enter the lesser sac by making an incision in the gastrocolic ligament and apply pressure from within the lesser lac. There has been no report of a recurrent Foramen of Winslow hernia.

In the case of our patient the right colon was found to be herniated through the Foramen of Winslow into the lesser sac and was dilated with serosal tears of the cecum with early ischemic changes.  The lesser sac was opened and a R hemicolectomy was performed. The pt recovered uneventfully.  This case was courtesy of Laura Wallace.

Van Daele E, Poortmans M, Vierendeeis T, et al. Herniation through the foramen of Winslow: a laparoscopic approach.  Hernia 2011; 15(4): 447-9.

Osvaldt AB, Mossmann DF, Bersch VP. Rohde L. Intestional obstruction caused by a foramen of winslow hernia. Am J Surg2008;196(2): 242-4.

Tee CL, Stephensen B, Dissanaqake T. Foramen of Winslow Hernia: A case report and literature review. Annals of Colorectal Research 2014;2(4), e25656.

Joo YE, Kim HS, Choi SK, et al. Internal hernia presenting as obstructive jaundice and acute pancreatitis. Scand J. Gastroenterol. 2002;37: 983-986.