Foramen of Winslow hernia involving the cecum and colon: a rare case report

Background: Herniation through the foramen of Winslow is a rare form of internal hernia, accounting for approximately 8% of such cases. It can present with nonspecific gastrointestinal symptoms and may result in closed-loop obstruction or strangulation, making diagnosis and timely intervention challenging. Case Presentation: A 71-year-old woman presented with acute right upper quadrant abdominal pain and vomiting. Initial evaluation, including ultrasound and laboratory tests, was inconclusive. A contrast-enhanced computed tomography (CT) scan revealed cecal herniation through the foramen of Winslow with partial closed-loop obstruction. Exploratory laparotomy confirmed herniation of the cecum and ascending colon through a markedly enlarged foramen. A right hemicolectomy with end-to-side ileocolic anastomosis was performed. To prevent recurrence, the greater omentum was placed into the foramen. The patient recovered uneventfully and remained asymptomatic at follow-up. Discussion: Anatomical anomalies such as an elongated mesentery and mobile colon can predispose to herniation through an enlarged foramen of Winslow. CT imaging plays a pivotal role in diagnosis. Given the risk of strangulation, prompt surgical intervention is essential. In select cases, anatomical repositioning using omental plugging may reduce the risk of recurrence. Conclusion: Although rare, foramen of Winslow hernia should be considered in the differential diagnosis of unexplained abdominal pain. Early CT-based diagnosis and timely surgical intervention are critical to avoid life-threatening complications.