A surgical case report of an epiploic hernia - A mobile right colon herniating through the foramen of Winslow

Abstract

Introduction: An Epiploic Hernia is an extremely rare type of abdominal hernia with <0.1 % incidence where the bowel or other intra-abdominal contents herniate through the Foramen of Winslow. A case of an Epiploic hernia in a middle-aged female is presented here.

Presentation of case: A woman in her 60s was admitted to a tertiary level hospital with severe right sided intermittent upper abdominal pain associated with nausea, bloating and constipation. The symptoms were thought to be due to biliary colic and managed conservatively. Since the symptoms persisted and a computed tomography scan of abdomen was organized. CT scan showed that the caecum was in the upper left quadrant. A laparoscopy was performed and demonstrated that her right colon was mobile herniating through the Foramen of Winslow into the lesser sac. The hernia was reduced, and the bowel was viable. The patient was discharged with no complications.

Discussion: There have been case reports of small bowel as the content of the hernia with lesser occurrences of caecum, ascending colon, transverse colon, gall bladder, omentum, or Meckel's diverticulum. A caecal herniation through the Foramen of Winslow is reported only with an incidence of 0.02 %. <10 % of these Epiploic hernias are diagnosed preoperatively making it a potentially life-threatening condition if not treated promptly due to high risk of bowel strangulation and mortality of up to 50 %.

Conclusion: A high index of suspicion is needed for the diagnosis of this internal hernia and radiological investigation is fundamental in making this diagnosis for allowing prompt surgical treatment.

Keywords: Blandin's hernia; Epiploic hernia; Foramen of Winslow; Internal hernia; Mobile right colon.

Fig. 1

a. Axial CT representation showing caecum lying in the lesser sac. Fig. 1b. Axial Representation of the Epiploic Hernia. Fig. 1c. Coronal view of CT scan showing the caecum sitting in the lesser sac. Fig. 1d. Coronal oblique view showing the caecum and terminal ileum herniating into the lesser sac through the epiploic foramen.