Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Jul 10;17(7):e87658.
doi: 10.7759/cureus.87658. eCollection 2025 Jul.

Laparoscopic Management of a Rare Lesser Sac Internal Hernia Involving the Terminal Ileum and Entire Right Colon: A Diagnostic and Surgical Challenge

Farhan Akram  1 , Abdulrahman Mohammed  1 , Khurram Siddique  1
Affiliations
Case Reports

Laparoscopic Management of a Rare Lesser Sac Internal Hernia Involving the Terminal Ileum and Entire Right Colon: A Diagnostic and Surgical Challenge

Farhan Akram et al. Cureus. .

Abstract

Internal hernias are an uncommon cause of bowel obstruction. The diagnosis and identification of the cause of internal herniation can be challenging, but modern imaging, particularly CT scan, facilitates preoperative identification. The foramen of Winslow hernia represents a rare subtype, accounting for a small fraction of all internal hernias and often presenting with non-specific symptoms. Most reported cases in the literature were managed through open surgery, albeit a few favored laparoscopy. This report presents a challenging case involving herniation of the terminal ileum, cecum, and ascending and transverse colon through the foramen of Winslow. We share the successful laparoscopic management, highlighting the surgical challenges and techniques used in this rare presentation.

Keywords: bowel obstruction; foramen of winslow; internal hernia; laparoscopic management; lesser sac.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Axial section through the upper abdomen
The yellow arrow shows the displaced cecum within the gastrohepatic space at the lesser sac.
Figure 2
Figure 2. Coronal section
The yellow arrow shows part of the colon within the lesser sac.
Figure 3
Figure 3. Sagittal section
The yellow arrow shows herniation of the right colon and distended cecum within the lesser sac.
Figure 4
Figure 4. Abdominal X-ray after Gastrografin
The yellow arrow demonstrates that the Gastrografin has successfully reached the sigmoid colon.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Review of internal hernias: radiographic and clinical findings. Martin LC, Merkle EM, Thompson WM. AJR Am J Roentgenol. 2006;186:703–717. - PubMed
    1. Intestinal obstruction caused by a foramen of Winslow hernia. Osvaldt AB, Mossmann DF, Bersch VP, Rohde L. Am J Surg. 2008;196:242–244. - PubMed
    1. Internal hernias: a difficult diagnostic challenge. Review of CT signs and clinical findings. Lanzetta MM, Masserelli A, Addeo G, et al. Acta Biomed. 2019;90:20–37. - PMC - PubMed
    1. Foramen of Winslow hernia: a review of the literature highlighting the role of laparoscopy. Moris D, Tsilimigras DI, Yerokun B, et al. J Gastrointest Surg. 2019;23:2093–2099. - PubMed
    1. Large bowel obstruction secondary to a cecal bascule with internal herniation through the foramen of Winslow: a case report. Mulkey E, Stewart G, Enrique E, El-Sabrout R. Int J Surg Case Rep. 2022;94:107123. - PMC - PubMed

Publication types

LinkOut - more resources