A Case of Intestinal Herniation Through the Foramen of Winslow

Toshiki Rikiyama^{1) 2)}, Yoshinobu Takahashi³⁾, Syun-ichi Kimura²⁾, Seiki Matsuno²⁾, Norihiro Suzuki, Takaaki Takebe⁴⁾

¹⁾The First Department of Surgery, Tohoku University School of Medicine
²⁾Department of Surgery, Mizusawa Hospital
^3)>Department of Surgetry, Mito Kyodo Hospital
⁴⁾Department of Internal Medicine, Mizusawa Hospital

A 63-year-old man visited our hospital complaining of severe upper abdominal pain and was admitted with a diagnosis of intestinal obstruction. Abdominal X-ray films showed several air-fluid levels located on the Th₁₂ and L₁ vertebrae, and interruption of small-bowel gas on the right side of the Lr vertebra. An enema examination with water-soluble contrast medium revealed a distal ileum crossing the transverse colon and tapering on the right side of the L₁ vertebra. With the preoperative diagnosis of intestinal herniation through the foramen of Winslow, an emergency laparotomy was performed. Operative findings showed that a loop of distal ileum was incarcerated through the foramen of Wnslow into the lesser sac. The gangrenous ileal segment approximately 70 cm in length was resected. Only 16 patients with hernia through the foramen of Winslow have been reported in Japan, and in these patients it was difficult to make a preoperative diagnosis. In this case, we could make the diagnosis preoperatively from abdominal X-ray films and the valuable findings of an enema examination.

Key words
foramen of Winslow, internal hernia, ileus

Reprint requests
Toshiki Rikiyama The First Department of Surgery, Tohoku University School of Medicine
1-1 Seiryo-machi, Aoba-ku, Sendai, 980-27 JAPAN

Accepted
February 14, 1996

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