Through the Foramen and Beyond: A Case Report of Internal Herniation of Caecum Through the Epiploic Foramen of Winslow

Internal herniae are a rare subtype of hernia defined by the protrusion of a viscus through the opening in the peritoneum or mesentery within the abdominal cavity. Herniation into the lesser sac through the epiploic foramen of Winslow is an uncommon subclassification of internal abdominal hernia. They are an important clinical entity and carry a high mortality risk if strangulation is present. This case report describes an 82-year-old female patient who presented with an acute onset of abdominal pain and distension. Initial computerised tomography imaging suggested caecal volvulus as a working diagnosis, prompting an emergency laparotomy. Intraoperatively, a right hemicolectomy was performed for a strangulated caecum herniated into the lesser sac via the epiploic foramen of Winslow. Postoperatively, this patient recovered well. This rare subtype of internal hernia can be challenging to diagnose preoperatively, leading to a delay in surgical intervention, conveying a high mortality rate. Our case highlights that early intervention in this setting leads to good post-operative outcomes.