eP500 - Right Hemicolectomy for Foramen of Winslow Hernia

Purpose/Background: Internal hernias through the foramen of Winslow are extremely rare. A 68 year old female with significant cardiac history presented with twelve hours of acute onset epigastric abdominal pain without peritonitis. She had a mild leukocytosis without other significant laboratory abnormalities. Computer tomography revealed herniated cecum and ascending colon through the foramen of Winslow.Methods/Interventions: The patient was taken emergently to the operative room for exploratory laparotomy. The lesser sac was entered and the entire right colon had herniated through the foramen of Winslow. The bowel was congested but viable and easily reduced. Open right hemicolectomy with primary stapled anastomosis was performed to prevent recurrence. The internal hernia defect was not closed. Total operative time was 129 minutes.Results/Outcomes: The patient recovered well with return of bowel function post operative day five and was discharged post operative day seven.Conclusion/

Discussion: Foramen of Winslow hernias represent approximately 0.08% of all hernias. Most of these hernias involve small bowel with large bowel and gallbladder herniation also being reported. Timely surgical management is the treatment of choice but intra operative decision making can vary. This patient had risk factors for development of this rare hernia including prior cholecystectomy and excessive viscera mobility. We chose to resect the excessively mobile right colon and not close the defect.Coronal and Sagittal Computer Tomography ScanA. Stomach B. Portal Vein C. Right Colon