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. 2024 Jan 4;86(3):1647–1653. doi: 10.1097/MS9.0000000000001540

Retroperitoneal cecal volvulus: a complication of a rare internal hernia – a case report

Imad Kamaleddine a,*, Magdalena Popova a, Theresa Angles a, Manuela Neese a, Beate Brinkmann b, Erik Volmer c, Marc-André Weber c, Georg Lamprecht b, Clemens Schafmayer a, Ahmed Alwali a
PMCID: PMC10923356  PMID: 38463092

Abstract

Introduction and importance:

The foramen of Winslow hernia (FWH) is a rare type of internal hernia. In one-third of cases, the cecum was found in the lesser sac. More rarely, the herniated cecum might be volvulated, which represents 1–1.5% of the causes of intestinal obstruction. Once diagnosed, surgical reduction and/or resection of the nonviable herniated bowel is crucial for a positive outcome.

Case presentation:

The authors report a case of retroperitoneal cecal volvulus that complicated FWH in a patient with a history of laparoscopic cholecystectomy.

Clinical discussion:

A delay in the diagnosis is associated with high morbidity and even higher mortality. Because of lacking a consensus, the treatment of FWH depends on the team’s surgical experience.

Conclusion:

Reporting this case will help us to keep in mind this differential diagnosis while treating patients in our daily practice.

Keywords: case report, cecal volvulus, foramen of Winslow hernia, internal hernia, intestinal obstruction

Case description

Highlights

  • The Foramen of Winslow hernia represents a rare type of internal hernias.

  • A cecal volvulus is a rare case of intestinal obstruction representing 1–1.5% of all cases.

  • A radiological exam, usually a computed tomography scan, should be performed.

  • A high clinical suspicion should be raised once a part of the bowel is found in the lesser sac.

  • Surgery is the treatment of choice with nowadays no consensus or guideline.

  • Most of the published cases are case reports.

The SCARE criteria were followed in reporting this case report1. We present the case of an 83-year-old woman, who was admitted through the emergency department few hours after the sudden onset of thoracic and upper abdominal pain associated with vomiting. The pre-existing conditions include: laparoscopic cholecystectomy, history of percutaneous coronary intervention and drug-eluting stent implantation in the right coronary artery, and left anterior descending artery/first diagonal branch (D1), transcatheter aortic valve implantation for high-grade aortic stenosis and mitral/tricuspid valve insufficiency, renal insufficiency (stage G3a), type II diabetes mellitus, arterial hypertension, dyslipoproteinemia, history of basal cell carcinoma, and restless legs syndrome. The physical examination showed a cachectic patient with no jugular vein congestion or peripheral edema on auscultation, a regular heart rhythm with no murmurs, an unremarkable pulmonary examination, and a distended abdomen with no signs of peritonitis. Upon admission, a synthetic opioid, Piritramid 7.5 mg was intravenously (iv) administered. The patient was initially pain-free but experienced a pain recurrence shortly after that. Computed tomography (CT)-scan of both thorax and abdomen with with iv contrast-enhancement excluded a possible aortic dissection and showed signs of intestinal transit disorder in the left upper abdomen and a distended transverse colon without signs of mesenteric ischemia (Fig. 1). Subileus was diagnosed and conservative treatment was initiated, including gastric and rectal tube installation, fluid therapy, correction of hypokalemia, proton pump inhibitor, analgesic, and antibiotic therapy. Under this treatment, the patient showed no remarkable improvement. Colonoscopy and gastroscopy under fluoroscopy were then performed. Due to stool soiling, only the transverse colon could be reached but was not dilated as suggested in the CT. However, a tumoral stenosis was ruled out and an intestinal decompression tube was inserted. The concomitant gastroscopy also showed no signs of malignancy or stenosis. After repositioning the nasogastric (NG) tube, water-soluble contrast medium (Peritrast 400 mg, Köhler Pharma) was administered through both tubes and an abdominal radiography was performed. Unexpectedly, neither the contrast via the NG-tube nor the colonic decompression tube stained or reached the the large, air-filled, coffee bean-shaped structure in the upper left abdomen (Fig. 2). In the following hours, the rectal decompression tube was dislocated, the patient’s abdomen remained distended and painful. Due to these unclear findings a new interdisciplinary discussion took place. The physical examination showed diffused abdominal pain with signs of local peritonitis in the epigastrium. In the context of the upon mentioned findings and the clinical condition of the patient there was a clear indication for exploratory laparotomy. An informed consent was obtained. A median laparotomy was performed. The intraoperative findings showed ascites with omental adhesions (postcholecystectomy), dilated small bowels and a slim colon transverse and left colon. The small intestine was followed from the Treitz band and surprisingly was fixed in the right upper quadrant. The Lesser sac was widely opened and just then the diagnosis was clear: cecal volvulus after herniation through the foramen of Winslow (Fig. 3). The cecum was then decompressed by a purse-string suture and appendectomy. The cecal wall was ischemic (Fig. 4), and as a consequence a right hemicolectomy with side-to-side anastomosis was performed. The postoperative course was uneventful. A regular diet was tolerated and the patient was discharged on the ninth postoperative day in good condition.

Figure 1.

Figure 1

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Contrast-enhanced computed tomography scan in the portal-venous phase of the upper abdomen showing the dilated colon next to the stomach.

Figure 2.

Figure 2

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Fluoroscopy after colposcopy and contrast administration through the NGT: neither the NG-tube nor the colonic decompression tube stain or reach the large gas filled lumen arguing against it being the transverse colon or the stomach.

Figure 3.

Figure 3

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Herniated cecum in the lesser sac.

Figure 4.

Figure 4

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Ischemic cecum after decompression.

Discussion

The first reported case of the foramen of Winslow hernia (FWH) was published in 1834 through Philippe-Frederic Bladin as an incidental postmortem finding. Since then, ~200 such cases have been reported worldwide (Table 1). FWH accounts for 8% of internal hernias and 0.08% of all hernias37. In one-third of the cases, the hernia included the cecum and ascending colon113. Among the possible causes of predisposition are: an enlarged foramen of Winslow, an abnormally long small bowel mesentery, persistence of the ascending mesocolon that allows marked mobility of the bowel, and an elongated right hepatic lobe4,57,114. On the other hand, cecal volvulus accounts for 1% of large bowel obstruction causes113. This manifestation has two forms with the more common one involving an axial twist of the ileum, cecum, and proximal ascending colon around its mesentery. The other form, called cecal bascule, accounts for 10% of the cases and involves the folding of the cecum upward toward the hepatic115. Cecal volvulus, once untreated, is usually associated with a high mortality rate that reaches 48%109. This happens usually due to vascular involvement and delayed diagnosis45,114.

Table 1.

Summary of all the previous published cases

N Authors Type of publication Year of publication Number of cases History of cholecystectomy Herniated organ
1 JE Engstad2 Case report 1919 1 No Small bowel
2 WG McKenzie and D Wood3 Case report 1925 1 No Small bowel
3 JM Erskine4 review 1967 90 No —
4 JM Erskine5 Case report 1967 1 No Cecum
5 CD Haynes et al.6 Case report 1968 1 No —
6 Dainko et al.7 Case report 1970 1 No Ileum, right colon
7 W Morioka et al.8 Case report 1970 1 No Cecum
8 UD Campbell9 Case report 1971 1 No Cecum
9 IJ Malter et al.10 Case report 1973 1 No Cecum
10 RK Harned et al.11 Case report 1974 1 No Ileum and Cecum
11 L Riedler et al.12 Case report 1975 1 No Ileum, right and transverse colon
12 R Ohkuma et al.13 Case report 1977 1 No Small bowel
13 DJ Cohen et al.14 Case report 1982 1 No Cecum
14 B Sorin et al.15 Case report 1982 1 No Cecum
15 CP Valenziano et al. 16 Case report 1987 1 Yes Ascending colon
16 J Delamarre et al.17 Case report 1988 1 No Cecum
17 TL Tran et al.18 Case report 1989 2 No 1-right colon
2-Ileum
18 W Lemish et al.19 Case report 1989 1 No Cecum
19 JW Greve et al.20 Case report 1990 1 No Ileum and Cecum
20 JJ Tjandra et al.21 Case report 1991 1 No Right colon
21 S Beizig et al.22 Case report 1992 1 No Ascending colon
22 MR Schuster et al.23 Case report 1992 1 No Cecum
23 E Senati et al.24 Case report 1994 1 No Right colon
24 V Evrard et al.25 2 Case reports 1996 2 No 1-right colon
2-Ileum
25 J Nagahori26 Case report 1996 1 No Gallbladder
26 CC Chung et al.27 Case report 1997 1 No Small bowel
27 Y Saida et al.28 Case report 2000 1 No Small bowel
28 MJ Orseck et al.29 Case report 2000 1 No Right flexure
29 TD Samson et al.30 Case report 2001 1 No Cecum
30 PB Rich et al.31 Case report 2002 1 No Right colon
31 Antao et al.32 Case report 2005 1 No Ileum
32 SS Forbes et al.33 Case report 2006 1 No Ascending colon
33 LM Pernice et al.34 Case report 2006 1 No Transverse colon
34 G Da Costa et al.35 Case report 2007 1 No Cecum
35 CE Koh et al.36 Case report 2007 2 No 1-Gallbladder
2-Cecum
36 AB Osvaldt et al.37 Case report 2007 1 No Small bowel
37 D Kanellos et al.38 Case report 2008 1 No Ileum, right colon
38 A Mbovo et al.39 Case report 2008 1 No Ileum
39 J Izumi et al.40 Case report 2009 1 No Gallbladder
40 M. Iribarren Diaz et al.41 Case report 2009 1 No Ascending colon
41 Rajeswaran et al.42 Case report 2009 1 No Cecum
42 K Ray et al.43 Case report 2009 1 No Cecum
43 LH Webb et al.44 Case report 2009 1 No Ascending colon
44 AR Azar et al. 45 Case report 2010 1 No Ileum and Cecum
45 K MacDonald et al.46 Case report 2010 1 No Ileum, right colon
46 AD Clough et al.47 Case report 2011 1 No Transverse colon
47 Stahlfeld KR et al.48 Case report 2011 1 No Small bowel
48 E Van Dael et al.49 Case report 2011 1 No Right colon
49 SF Powell-Brett et al.50 Case report 2012 1 No Cecum
50 RL Smith et al.51 Brief report 2012 1 No Ileum, right colon
51 CR Gonzalez et al.52 2 Case reports 2013 2 No 1-Small bowel
2-Cecum, Ileum
52 Lin et al.53 Case report 2013 1 No Ileum
53 A May et al.54 Case report 2013 1 No Small bowel
54 K Numata et al.55 Case report 2013 1 No Gallbladder
55 V Patel et al.56 Case report 2013 1 No Cecum
56 CA Puig et al. 57 Case report 2013 1 No Right colon
57 T Yamashiro et al.58 Case report 2013 1 No Ileum
58 T Dissanayake et al.59 Case report 2014 1 No Cecum
59 P Sikiminywa-Kambale et al. 60 Case report 2014 1 No Cecum
60 T Makarawo et al.61 Case report 2014 1 No Cecum
61 J Ryan et al.62 Case report 2014 1 No Right colon
62 CL Tee et al.63 Case report 2014 1 No Small bowel
63 S Nazarian et al.64 Case report 2015 1 No Small bowel
64 CR Harnsberger et al. 65 Case report 2015 1 No Cecum and Ileum
65 M Ozsoy et al.66 Case report 2015 1 No Cecum and Ileum
66 PN Brandao et al.67 Case report 2016 1 No Transverse colon
67 LE Duinhouwer et al.68 Case report 2016 1 No Ascending colon
68 R Daher et al.69 Case report 2016 1 No Cecum and Ileum
69 S Garg et al.70 Case report 2016 1 No Cecum and Ileum
70 LS Kirigin et al.71 Case report 2016 1 No Small bowel
71 V Sobek et al.72 Case report 2016 1 No Cecum
72 E Leung et al.73 Case report 2016 1 No Small bowel
73 G Tse et al. 74 Case report 2016 1 No Cecum
74 HG Cho et al.75 Case report 2017 1 No Small bowel
75 Y Ichikawa et al.76 Case report 2017 1 No Small bowel
76 J Nguyen et al.77 Case report 2017 1 No Cecum
77 J Patel et al.78 Case report 2017 1 No Cecum
78 BW Deschner et al.79 Case report 2018 1 No Cecum
79 A Haddad et al.80 Case report 2018 1 No Small bowel
80 YJL Jansen et al.81 Case report 2018 1 No Cecum
81 K Shek et al.82 Case report 2018 1 No Cecum
82 P Downs et al.83 Case report 2018 1 No Ileum, right and transverse colon
83 S Fujihata et al.84 Case report 2018 1 No Small bowel
84 F Ayoob et al.85 Case report 2019 1 No Ileum and Cecum
85 P Charters et al. 86 Case report 2019 1 No Cecum
86 D Moris et al.87 Review 2019 15 No —
87 YA Mahnashi et al.88 Case report 2019 1 No Right colon
88 M Azer et al.89 Case report 2020 1 No Right colon
89 C Buisset et al.90 Case report 2020 1 No Right colon
92 YM Cho et al.91 Case report 2020 1 No Cecum
93 E Ristiyanto et al.92 Case report 2020 1 No Small bowel
94 M Sammut et al.93 Case report 2020 1 No Cecum
95 I Sravya et al.94 Case report 2020 1 No Small bowel
96 S Akhtar et al.95 Case report 2021 1 No Cecum
97 PKBSC Bandara et al.96 Case report 2021 1 No Small bowel
98 EA Karlsen97 Case report 2021 1 No Small bowel
99 AM. Williams et al.98 Case report 2021 1 No Cecum
101 N Naqeeb et al. 99 Case report 2021 1 Yes Cecum
102 S Honma et al.100 Case report 2021 1 No Small bowel
103 D Chandhrasekhar et al.101 Case report 2022 1 No Ileum, right colon
104 SL Carpenter et al.102 Case report 2022 1 No Cecum
105 AL Titan et al.103 Case report 2022 1 No Small bowel
106 A Kharkhash et al.104 Case report 2022 1 No Cecum
107 EL Monteiro et al.105 Case report 2022 1 No Ileum, right colon
108 H Honda et al.106 Case report 2022 1 No Right colon
109 Y Huang et al.107 Case report 2022 1 No Small bowel
110 SM Mansoor et al.108 Case report 2022 1 No Cecum
111 A Perabo et al. 109 Case report 2022 1 No Cecum
112 V Tatagari et al.110 Case report 2022 1 No Ascending colon
113 E Mulkey et al.111 Case report 2022 1 No Cecum
114 HWL de beaufort et al.112 Case report 2023 1 No Small bowel
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The initial symptoms of FWH are usually nonspecific and can include both upper abdominal and chest pain86. The diagnosis should be expected once on radiological examinations an air-filled structure is seen in the left upper quadrant. However, this is achieved preoperatively in only 10% of cases116. An urgent surgical management involves reduction of the herniated bowel and might be followed by cecopexy and/or closure of the foramen of Winslow. Once bowel ischemia is present, resection should be performed57,60. Both open and minimal invasive surgeries have been reported65,74.

In our case, after ruling out cardiorespiratory distress, the patient was treated conservatively for subileus. Failure of this therapy and the persisting presence of the air-filled coffee bean structure between both stomach and colon on the fluoroscopy with the developing signs of local peritonitis led to the surgical intervention. The initial clinical examination showed no signs of peritonitis and the CT-scan interpreted the dilated colon in the left upper quadrant as transverse colon and excluded mesenteric ischemia. We began a conservative therapy and the surgical treatment was delayed for 48 h. Ferguson et al. in 2008 reviewed the literature for cases of intestinal volvulus as a possible postcholecystectomy complication. Among the 12 published cases, three involved an intraperitoneal cecal volvulus117. Interestingly, retroperitoneal cecal volvulus (in the lesser sac through FWH) was also reported twice as a possible complication of laparoscopic cholecystectomy16,99. Although it is just speculation, to our knowledge, this case is the third reported case of the rare cecal volvulus after herniation through the foramen of Winslow and a history of cholecystectomy.

Conclusion

This case demonstrates that even with suitable diagnostic imaging, the initial diagnosis of FWH is not always easy. It also proves the significance of maintaining a strong level of clinical suspicion, especially for the rarest cases. A consensus on the management of this rare clinical manifestation is lacking. However, good clinical suspicion and prompt surgical management are essential for a positive outcome.

Ethical approval

An ethical approval was not required. A written informed consent was obtained from the patient for publication of this case report with any accompanying images.

Consent

The authors testify the patient privacy maintenance. Written informed consent was obtained from the patient for publication of this case report and accompanying images. The authors ensure that all the figures/photos are suitably anonymised with no patient information or means of identifying the patient.

Sources of funding

No funding was provided for this case.

Author contribution

I.K.: operated on the patient and proposed the writing of the manuscript; C.S.: took the role of supervision; I.K., M.P., and A.A.: wrote the preliminary version of the manuscript, prepared the images, and regulated the necessary files; T.A. and M.N.: assisted at the operation; G.L. and B.B.: performed the endoscopic exams; E.V. and M.A.W.: performed the radiological exams. All authors have read and approved the manuscript.

Conflicts of interest disclosure

The authors have no conflicts of interest to declare.

Research registration unique identifying number (UIN)

As a case report, no registration of research is needed.

Guarantor

Imad Kamaleddine and Clemens Schafmayer.

Data availability statement

All needed data are available upon reasonable request.

Provenance and peer review

The paper was not invited.

Footnotes

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Published online 4 January 2024

Contributor Information

Imad Kamaleddine, Email: imad.kamaleddine@med.uni-rostock.de.

Magdalena Popova, Email: mag_popova@hotmail.com.

Theresa Angles, Email: theresa.angles@med.uni-rostock.de.

Manuela Neese, Email: manuela.neese@med.uni-rostock.de.

Beate Brinkmann, Email: beate.brinkmann@med.unni-rostock.de.

Erik Volmer, Email: erik.volmer@med.uni-rostock.de.

Marc-André Weber, Email: Marc-Andre.Weber@med.uni-rostock.de.

Georg Lamprecht, Email: georg.lamprecht@med.uni-rostock.de.

Clemens Schafmayer, Email: clemens.schafmayer@med.uni-rostock.de.

Ahmed Alwali, Email: ahmed.alwali@med.uni-rostock.de.

References

  • 1.Agha RA, Franchi T, Sohrabi C, et al. The SCARE 2020 guideline: updating consensus Surgical CAse REport (SCARE) Guidelines. Int J Surg 2020;84:226–230. [DOI] [PubMed] [Google Scholar]
  • 2.Engstad JE. Hernia through the foramen of Winslow: report of a case. JAMA 1919;72:411–412. [Google Scholar]
  • 3.McKenzie WG, Wood D. Strangulated hernia through the foramen of Winslow. Br J Surg 1925;12:613–614. [Google Scholar]
  • 4.Erskine JM. Hernia through the foramen of Winslow. Surg Gynecol Obstet 1965;161:592. [PubMed] [Google Scholar]
  • 5.Erskine JM. Hernia through the foramen of Winslow. A case report of the cecum incarcerated in the lesser omental cavity. Am J Surg 1967;114:941–947. [DOI] [PubMed] [Google Scholar]
  • 6.Haynes CD, McSwain NE, Srone HH, et al. Hernia through the foramen of Winslow: report of a case. Am Surg 1968;34:687–689. [PubMed] [Google Scholar]
  • 7.Dainko EA. Incarcerated foramen of Winslow hernia. Surg Clin North Am 1970;50:1015–1020. [DOI] [PubMed] [Google Scholar]
  • 8.Morioka W, Keltner RN. Cecal volvulus with herniation through foramen of Winslow. JAMA 1970;213:1194. [PubMed] [Google Scholar]
  • 9.Campbell UD. A case of volvulus of the cecum combined with herniation through the foramen of Winslow. Ugeskrift for Laeger 1971;133:2069–2071. [PubMed] [Google Scholar]
  • 10.Malter IJ, Furman RW, Kunitz SN. Herniation of the cecum through the foramen of Winslow: radiographic diagnosis and report of a case. Dis Colon Rectum 1973;16:64–66. [DOI] [PubMed] [Google Scholar]
  • 11.Harned RK, Farley GE. Herniation of cecum and terminal ileum through the foramen of Winslow. Am J Gastroenterol 1974;61:304–307. [PubMed] [Google Scholar]
  • 12.Riedler L, Haselbach H, Schwamberger K. Bursa omentalis hernia through Winslow's foramen. Chirurg 1975;46:382–384. [PubMed] [Google Scholar]
  • 13.Ohkuma R, Miyazaki K. Hernia through the foramen of Winslow. Jpn J Surg 1977;7:151–157. [DOI] [PubMed] [Google Scholar]
  • 14.Cohen DJ, Schoolnik ML. Herniation through the foramen of Winslow. Dis Colon Rectum 1982;25:820–822. [DOI] [PubMed] [Google Scholar]
  • 15.Sorin B, et al. Ann Radiol 1982;25:217–221. [PubMed] [Google Scholar]
  • 16.Valenziano CP, Howard WB, Criado FJ. Hernia through the foramen of Winslow: a complication of cholecystectomy. A case report. Am Surg 1987;53:254–257. [PubMed] [Google Scholar]
  • 17.Delamarre J, Henry X, Jouet-Gondry C, et al. Cecal hernia through Winslow's foramen. Radiographic study of a case and review of the literature. Journal de Radiologie 1988;69:459–464; PMID: 3047378. [PubMed] [Google Scholar]
  • 18.Tran TL, Pitt PC. Hernia through the foramen of Winslow. A report of two cases with emphasis on plain film interpretation. Clin Radiol 1989;40:264–266. [DOI] [PubMed] [Google Scholar]
  • 19.Lemish W, Cameron D. Caecal Herniation Through the Foramen of Winslow. Australas Radiol 1989;33:109–110. [DOI] [PubMed] [Google Scholar]
  • 20.Greve JW, Gouma DJ. Herniation of cecum and terminal ileum through Winslow's foramen: a case report. Neth J Surg 1990;42:56–57. [PubMed] [Google Scholar]
  • 21.Tjandra JJ, Collier N. Obstructive jaundice due to foramen of Winslow hernia: a case report. Aust N Z J Surg 1991;61:467–469. [DOI] [PubMed] [Google Scholar]
  • 22.Beizig S, Sable Y, Boulaire JL, et al. Hernie étranglée du colon droit à travers l'hiatus de Winslow. A propos d'une observation Strangulated hernia of the right colon through the foramen of Winslow. Report of a case. J Chir (Paris) 1992;129:38–40. [PubMed] [Google Scholar]
  • 23.Schuster MR, Tu RK, Scanlan KA. Caecal herniation through the foramen of Winslow: diagnosis by computed tomography. Br J Radiol 1992;65:1047–1048. [DOI] [PubMed] [Google Scholar]
  • 24.Senati E, Rizzo M, Crescenzi U, et al. Erniazione del cieco e colon ascendente attraverso lo iato di Winslow e il piccolo omento. Presentazione di caso clinico Herniation of the cecum and ascending colon through Winslow's foramen and the lesser omentum. A case report. Ann Ital Chir 1994;65:575–577. [PubMed] [Google Scholar]
  • 25.Evrard V, Vielle G, Buyck A, et al. Herniation through the foramen of Winslow. Report of two cases. Dis Colon Rectum 1996;39:1055–1057. [DOI] [PubMed] [Google Scholar]
  • 26.Nagahori J. Herniation of the gallbladder through the foramen of Winslow. Ryoikibetsu Shokogun Shirizu 1996;9:432–435. [PubMed] [Google Scholar]
  • 27.Chung CC, Leung KL, Lau WY, et al. Spontaneous internal herniation through the foramen of winslow: a case report. CJS 1997;40. [PMC free article] [PubMed] [Google Scholar]
  • 28.Saida Y, Nagao J, Takase M, et al. Herniation through both Winslow’s foramen and a lesser omental defect: Report of a case. Surg Today 2000;30:544–547. [DOI] [PubMed] [Google Scholar]
  • 29.Orseck MJ, Ross JP, Morrow CE. Herniation of the hepatic flexure through the foramen of Winslow: a case report. Am Surg 2000;66:602–603. [PubMed] [Google Scholar]
  • 30.Samson T, Tercero F, Sato K, et al. Cecal herniation through the foramen of Winslow after laparoscopic Nissenfundoplication. Surg Endosc 2001;15:1490. [DOI] [PubMed] [Google Scholar]
  • 31.Rich PB, Burke L, Cairns BA. Hernia of right colon and cecum through the foramen of Winslow and lesser omentum. J Am Coll Surg 2002;194:230. [DOI] [PubMed] [Google Scholar]
  • 32.Antao B, Hamill J, Samuel M, et al. Herniation through the foramen of Winslow presenting as obstructive jaundice. Pediatr Surg Int 2005;21:560–562. [DOI] [PubMed] [Google Scholar]
  • 33.Forbes SS, Stephen WJ. Herniation through the foramen of Winslow: radiographic and intraoperative findings. Can J Surg 2006;49:362–363. [PMC free article] [PubMed] [Google Scholar]
  • 34.Pernice LM, Bartolucci M, Mori V, et al. Transverse colon herniation through the foramen of Winslow presenting with unusual CT findings. J Gastrointest Surg 2006;10:1180–1183. [DOI] [PubMed] [Google Scholar]
  • 35.Da Costa G, Ng B, Kociumbas I, et al. Herniation of caecum through the foramen of Winslow. Australas Radiol 2007;51Spec No:B152–B154. [DOI] [PubMed] [Google Scholar]
  • 36.Koh CE, Woods SDS, Usatoff Val. Foramen of Winslow hernia. Surgical Practice 2007;11:81–83. [Google Scholar]
  • 37.Osvaldt AB, Mossmann DF, Bersch VP, et al. Intestinal obstruction caused by a foramen of Winslow hernia. Am J Surg 2008;196:242–244. [DOI] [PubMed] [Google Scholar]
  • 38.Kanellos D, Kockerling F, Moesta KT. Rare cause of acute pain in the left upper abdominal quadrant. Hernia 2008;12:659–661. [DOI] [PubMed] [Google Scholar]
  • 39.Mbovo A, Goura E, Massicot R, et al. An exceptional cause of intestinal obstruction in 2 years old boy: strangulated hernia of the ileum through Winslow’s foramen. J Paediatr Surg 2008;43:e1–e3. [DOI] [PubMed] [Google Scholar]
  • 40.Izumi J, et al. Gallbladder hernia into the foramen of Winslow: CT findings. Abdominal imaging 2009;34:734–736. [DOI] [PubMed] [Google Scholar]
  • 41.Iribarren Díaz M, Rivo Vázquez A, de Castro Parga G, et al. Hernia interna a través del hiato de Winslow asociada a rotación incompleta del intestino medio [Internal hernia through the foramen of Winslow associated with an incomplete rotation of the medium intestine]. Rev Esp Enferm Dig 2009;101:72–74; Spanish. [DOI] [PubMed] [Google Scholar]
  • 42.Rajeswaran G, Selvakumar S, King C. Internal herniation of the caecum into the lesser sac: an unusual cause of an acute abdomen (2009: 10b. Eur Radiol 2010;20:249–252. [DOI] [PubMed] [Google Scholar]
  • 43.Ray K, Snowden C, Khatri K, et al. Gastric outlet obstruction from a caecal volvulus, herniated through epiploic foramen: a case report. Case Reports 2009;2009:bcr0520091880. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Webb LH, Riordan WP. Internal herniation of the cecum through the foramen of Winslow. Am Surg 2009;75:1252–1253; PMID: 19999922. [PubMed] [Google Scholar]
  • 45.Rezazadeh Azar A, Abraham C, Coulier B, et al. Ileocecal herniation through the foramen of Winslow: MDCT diagnosis. Abdom Imaging 2010;35:574–577. [DOI] [PubMed] [Google Scholar]
  • 46.MacDonald K, et al. An unusual cause of obstructive jaundice in pregnancy. Abdominal imaging 2011;36:318–320. [DOI] [PubMed] [Google Scholar]
  • 47.Clough AD, Smith GS, Leibman S. Laparoscopic Reduction of an Internal Hernia of Transverse Colon Through the Foramen of Winslow. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 2011;21:e190–e191. [DOI] [PubMed] [Google Scholar]
  • 48.Stahlfeld KR, Edwards M, Sell HW. Image of the month. Foramen of Winslow hernia. Arch Surg 2003;138:561–562. [DOI] [PubMed] [Google Scholar]
  • 49.Van Daele E, Poortmans M, Vierendeels T, et al. Herniation through the foramen of Winslow: a laparoscopic approach. Hernia 2011;15:447–449. [DOI] [PubMed] [Google Scholar]
  • 50.Powell-Brett SF, Royle JT, Stone T, et al. Caecum herniation through the Foramen of Winslow. J Surg Case Rep 2012;2012:rjs016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Smith RL, Mansfield S, Wood T, et al. Extensive herniation and necrosis of the small and large bowel through the foramen of Winslow. The American Surgeon 2012;78:429–431. [PubMed] [Google Scholar]
  • 52.Gonzalez Conde R, Pardo Rojas P, Valeiras Dominguez E, et al. Correct preoperative diagnosis of herniation through the Foramen of Winslow: two case reports. Hernia 2013;17:409–414. [DOI] [PubMed] [Google Scholar]
  • 53.Lin WC, Lin CH, Lo YP, et al. Rapid pre-operative diagnosis of ileal hernia through the foramen of Winslow with multidetector computed tomography, enabling successful laparoscopic reduction. South African Journal of Surgery 2013;51:35–37. [DOI] [PubMed] [Google Scholar]
  • 54.May A, Cazeneuve N, Bourbao-Tournois C. Acute small bowel obstruction due to internal herniation through the Foramen of Winslow: CT diagnosis and laparoscopic treatment. J Visc Surg 2013;150:349–351. [DOI] [PubMed] [Google Scholar]
  • 55.Numata K, Kunishi Y, Kurakami Y, et al. Gallbladder herniation into the lesser sac through the foramen of Winslow: report of a case. Surg Today 2013;43:1194–1198. [DOI] [PubMed] [Google Scholar]
  • 56.Patel V, et al. Updates Surg 2013;65:241–244. [DOI] [PubMed] [Google Scholar]
  • 57.Puig CA, Lillegard JB, Fisher JE, et al. Hernia of cecum and ascending colon through the foramen of Winslow. Int J Surg Case Rep 2013;4:879–881. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 58.Yamashiro T, Ikeda H, Fujikawa A, et al. Internal hernia through the foramen of Winslow: the “narrowed portal vein” sign on abdominal CT. Emerg Radiol 2013;20:247–250. [DOI] [PubMed] [Google Scholar]
  • 59.Dissanayake T, Grieve D, Tee CL. Re: Internal herniation of the caecum through the foramen of Winslow. ANZ J Surg 2014;84:796. [DOI] [PubMed] [Google Scholar]
  • 60.Sikiminywa-Kambale P, Anaye A, Roulet D, et al. Internal hernia through the foramen of Winslow: a diagnosis to consider in moderate epigastric pain. J Surg Case Rep 2014;2014:rju065rju065. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61.Makarawo T, Macedo FI, Jacobs MJ. Cecal bascule herniation into the lesser sac. World J Clin Cases 2014;2:903–906. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.Ryan J, Jin S, Frank J, et al. Internal herniation of the caecum through the foramen of Winslow. ANZ J Surg 2014;84:95–96. [DOI] [PubMed] [Google Scholar]
  • 63.Tee CL, Stephensen B, Sloss Aet al. Yield of adenomas and colorectal cancers within 5 years of a negative colonoscopy: are the guidelines guiding? ANZ J Surg. 2018;88:E1-E5. [DOI] [PubMed]
  • 64.Nazarian S, Clegg D, Chang S, et al. Difficult diagnosis: internal herniation of the terminal ileum through the foramen of Winslow into the lesser sac. BMJ Case Rep 2015;2015:bcr2015212269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 65.Harnsberger CR, McLemore EC, Broderick RC, et al. Foramen of Winslow hernia: a minimally invasive approach. Surg Endosc 2015;29:2385–2388. [DOI] [PubMed] [Google Scholar]
  • 66.Ozsoy M, Ozkececi T, Akici M, et al. Internal herniation through the foramen of Winslow: a rare cause of bowel obstruction. ANZ Journal of Surgery 2017;87:E204–E205. [DOI] [PubMed] [Google Scholar]
  • 67.Brandão PN, Mesquita I, Sampaio M, et al. Foramen of Winslow hernia: case report of a minimally invasive approach. J Surg Case Rep 2016;2016:rjw205. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 68.Duinhouwer LE, Deerenberg E, Rociu E, et al. Herniation of the colon through the foramen of Winslow-A case report. Int J Surg Case Rep 2016;24:14–17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 69.Daher R, Montana L, Abdullah J, et al. Laparoscopic management of foramen of Winslow incarcerated hernia. Surg Case Rep 2016;2:9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 70.Garg SG, Flumeri-Perez G, Perveen S, et al. Laparoscopic repair of foramen of Winslow hernia. Int J Angiol 2016;25:64–67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 71.Kirigin LS, Nikolić M, Kruljac I, et al. Ileal herniation through the foramen of winslow: overeating as a risk factor for internal herniation. Acta Clin Croat 2016;55:167–171. [DOI] [PubMed] [Google Scholar]
  • 72.Sobek V, Chrostek M. Cecal herniation through the foramen of Winslow as a rare cause of ileus. RozhlChir 2016;95:291–293. [PubMed] [Google Scholar]
  • 73.Leung E, Bramhall S, Kumar P, et al. Internal herniation through foramen of Winslow: a diagnosis not to be missed. Clin Med Insights Gastroenterol 2016;9:21–33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 74.Tse G, Sollei T, Ali SM, et al. Caecal herniation through the foramen of Winslow. BJR|case reports 2016;2:20150330. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 75.Cho HG, Kang J. Spontaneous reduction of small bowel herniation through the foramen of Winslow: importance of a timely approach. Ann Surg Treat Res 2017;92:113–116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 76.Ichikawa Y, Kanazawa A, Dan N, et al. Case of ileal herniation through the foramen of Winslow diagnosed preoperatively by CT and treated with laparoscopic surgery. Asian J Endosc Surg 2017;10:328–330. [DOI] [PubMed] [Google Scholar]
  • 77.Nguyen J, Bashan KA, Danner OK, et al. A strangulated cecal volvulus through the foramen of Winslow, a rare presentation of internal herniation. The American Surgeon 2017;83:E200. [PubMed] [Google Scholar]
  • 78.Patel J, Tare P. A perforated caecal volvulus in the foramen of Winslow. BMJ Case Rep 2017;2017:bcr2017219475. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 79.Deschner BW, Schwulst SJ. Spontaneous reduction of acute cecal herniation through the foramen of Winslow. Journal of Surgical Case Reports 2018;2018rjy236, 10.1093/jscr/rjy236. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 80.Haddad A, Sebai A, Rhaiem R, et al. The Annals of The Royal College of Surgeons of England. 2018;100:e123–e124. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 81.Jansen YJL, Nieboer K, Senesael E, et al. Internal herniation through the foramen of Winslow: a case report. Acta Chir Belg 2020;120:136–138.Epub 2018 Oct 4. PMID: 30284522. [DOI] [PubMed] [Google Scholar]
  • 82.Shek K, Ditkofsky N, Ashamalla S, et al. A case report of caecal herniation through the foramen of Winslow. Ann R Coll Surg Engl 2018;100:e142–e144. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 83.Downs P, Downes N, Zayshlyy E, et al. Internal hernia through the foramen of Winslow. Journal of Surgical Case Reports 2018;2018rjy329, 10.1093/jscr/rjy329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 84.Fujihata S, Kitagami H, Yamamoto M, et al. A post-operative complication of foramen of Winslow hernia with left to right herniation of the small intestine: An extremely rare case report. Int J Surg Case Rep 2018;49:219–222. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 85.Ayoob F, Michael R, Chadnick Z, et al. Internal hernia of caecum through the foramen of Winslow. BMJ Case Rep 2019;12:e228239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 86.Charters P, Lowe A, Keogan R, et al. Caecal herniation through the foramen of Winslow: a lesser known complication of the lesser sac. J Gastrointest Abdom Radiol 2019;02:147–150. [Google Scholar]
  • 87.Moris D, Tsilimigras DI, Yerokun B, et al. Foramen of Winslow Hernia: a Review of the Literature Highlighting the Role of Laparoscopy. J Gastrointest Surg 2019;23:2093–2099. [DOI] [PubMed] [Google Scholar]
  • 88.Mahnashi YA, et al. Laparoscopic management of cecum and ascending colon hernia through the foramen of Winslow. Journal of surgical case reports 2019;2:rjz026. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 89.Azer M, Daniel A, Schuldes L, et al. Internal herniation of the caecum and the ascending colon through the foramen of Winslow. Journal of Surgical Case Reports 2020;3:rjaa029. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 90.Buisset C, et al. Laparoscopic management of an ascending colon hernia through the foramen of Winslow. Journal of Surgical Case Reports 2020;9:rjaa283. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 91.Cho YM, Behrenbruch C, Tartaglia Cet al. Caecal herniation and volvulus through the foramen of Winslow: a rare presentation. ANZ J Surg. 2020;90:930–932. [DOI] [PubMed] [Google Scholar]
  • 92.Ristiyanto E, Wibowo TA, Syaiful RA, et al. Hernia Through Winslow Foramen in Cipto Mangunkusumo General Hospital, Jakarta: A Case Report. The New Ropanasuri Journal of Surgery 2020;5(No. 1Article 9. doi: 10.7454/nrjs.v5i1.1064 [DOI] [Google Scholar]
  • 93.Sammut M, Barben C. Herniation of the caecum and ascending colon through the foramen of Winslow: a case report and review. Ann R Coll Surg Engl 2020;102:e39–e41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 94.Sravya I, Lakshminarayana B, Ramachandra L, et al. Indian Journal of Surgery(Vol. 82, Issue 4).
  • 95.Akhtar S, et al. Internal hernia through foramen of winslow: a case report. PJR 2021;31:2. [Google Scholar]
  • 96.Bandara PKBSC, Viraj Rohana AM, Pathirana A. Intestinal obstruction due to small bowel herniation through foramen of Winslow: a case report. Journal of Medical Case Reports 2021;15:1–4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 97.Karlsen EA, Keogh C, Sandstrom A, et al. Missed diagnosis of a foramen of Winslow internal hernia. ANZ J Surg 2021;91:E789–E790. [DOI] [PubMed] [Google Scholar]
  • 98.Williams AM, et al. Cecal bascule herniation through the foramen of Winslow. Autopsy and Case Reports 2021;11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 99.Naqeeb N, Krishnamoorthy S. Caecal volvulus in the lesser sac: a rare presentation of large bowel obstruction. ANZ J Surg 2021;91:2533–2534. [DOI] [PubMed] [Google Scholar]
  • 100.Honma S, et al. Laparoscopic surgery in a patient with foramen of Winslow hernia due to large uterine fibroids: a case report and literature. (2021). [DOI] [PMC free article] [PubMed]
  • 101.Chandhrasekhar D, et al. A Twisted Cecum: Herniation and Volvulus of the Cecum Through the Epiploic Foramen. Cureus 2022;14. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 102.Carpenter SL, Campbell J, Jayaraman V. Caecal volvulus in a foramen of Winslow hernia. BMJ Case Reports CP 2022;15:e247316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 103.Titan AL, Garagliano JM, Spain D. Trauma Surg Acute Care Open 2022;7:e000960. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 104.Kharkhach A, Police A, Mabilia A, et al. Journal of Surgical Case Reports 2022;8:1–3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 105.Monteiro EL, et al. A rare case of internal hernia through the foramen of Winslow. Journal of Surgical Case Reports 2022;2022:rjac065. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 106.Honda H, et al. Foramen of Winslow Hernia Ameliorating Conservatively. Internal Medicine 2022;61:2817–2818. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 107.Huang Y, et al. An adolescent with ileum herniation through foramen of winslow: A case report and literature review. Nigerian Journal of Clinical Practice 2022;25:1372–1376. [DOI] [PubMed] [Google Scholar]
  • 108.Mansoor SM, Ole JG, Fetveit T. Intern herniering gjennom Winslows foramen. Tidsskrift for Den norske legeforening 2022. [DOI] [PubMed] [Google Scholar]
  • 109.Perabo A, Alfaro A, Baty S, et al. An unusual presentation of cecal volvulus with internal herniation through the foramen of Winslow. Cureus 2022;14:e32960. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 110.Tatagari V, et al. Internal herniation of the right colon through the foramen of Winslow: A case report. International Journal of Surgery Case Reports 2022;94:107015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 111.Mulkey E, et al. Large bowel obstruction secondary to a cecal bascule with internal herniation through the foramen of Winslow: A case report. International Journal of Surgery Case Reports 2022;94:107123. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 112.de Beaufort, Hector WL, et al. Acute abdominal pain due to internal herniation: a rare phenomenon in a patient without relevant medical history. Nederlands Tijdschrift Voor Geneeskunde 2023;167:D6826. [PubMed] [Google Scholar]
  • 113.Lee SY, Bhaduri M. Cecal volvulus. CanMed Assoc J 2013;185:684684. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 114.Martin LC, Merkle EM, Thompson WM. Review of internal hernias: radiographic and clinical findings. Am J Roentgenol 2006;186:703–717. [DOI] [PubMed] [Google Scholar]
  • 115.Madiba TE, Thomson SR, Church JM. The management of cecal volvulus. Dis Colon Rectum 2002;45:264–267. [DOI] [PubMed] [Google Scholar]
  • 116.Armstrong O, Hamel A, Grignon B, et al. Internal hernias: anatomical basis and clinical relevance. Surg Radiol Anat 2007;29:333–337. [DOI] [PubMed] [Google Scholar]
  • 117.Ferguson L, Higgs Z, Brown S, et al. Intestinal volvulus following laparoscopic surgery: a literature review and case report. J Laparoendosc Adv Surg Techniq 2008;18:405–410. [DOI] [PubMed] [Google Scholar]

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