Spontaneous reduction of acute cecal herniation through the foramen of Winslow

Abstract

This is the case of a 70-year-old woman who presented to the emergency department complaining of 2 hours of acute-onset epigastric pain. She had experienced this pain once before which had spontaneously resolved. Axial imaging demonstrated the cecum in an abnormal position within the lesser sac, as well as compression of the inferior vena cava and portal vein. She was taken emergently to the operating room for laparotomy, where a free-floating cecum and ascending colon was identified without ischemia, and a right hemicolectomy was performed. Foramen of Winslow hernias are rare internal hernias with a high rate of strangulation and bowel ischemia, requiring urgent surgical intervention. Operative treatment depends on the type of herniated viscera. Spontaneous reduction is not well documented.

Figure 1:

The cecum is absent from the right lower quadrant and is located between the liver and stomach (red arrow) visualized as an air-fluid level (green arrow). Compression of the portal vein by herniated contents is demonstrated (blue arrow).

Figure 2:

Coronal view demonstrating FoW measurement and herniated contents. The stomach is demonstrated by the red arrow. The FoW is shown to be dilated at 4.4 cm.

Figure 3:

Axial view demonstrating multiple air-fluid levels posterior to the liver and adjacent to the stomach (red arrow).