Large-bowel herniation through the foramen of Winslow: a case report

Introduction and importance: Foramen of Winslow herniation is a rare type of internal hernia and an uncommon cause of intestinal obstruction. Early diagnosis is critical, as delayed recognition can lead to bowel ischemia and increased morbidity. This report contributes to the limited literature on large-bowel involvement and emphasises the value of prompt computed tomography (CT) imaging in reducing surgical morbidity. Presentation of case: A 46-year-old woman presented with acute abdominal pain and vomiting. CT demonstrated the cecum and ascending colon entrapped within the lesser sac, highly suggestive of a foramen of Winslow hernia. Differential diagnoses included small-bowel obstruction and internal hernia. Emergency laparotomy confirmed herniation of the cecum, ascending colon, and terminal ileum without ischemic changes. Reduction was achieved via gentle traction and decompression, followed by colopexy and cecopexy to prevent recurrence. No bowel resection was required. Clinical discussion: Foramen of Winslow hernias represent fewer than 0.1% of all internal hernias and often present with nonspecific symptoms, making pre-operative diagnosis challenging. Cross-sectional imaging, particularly CT, is essential for early identification. Surgical management involves reduction of the herniated bowel, assessment of viability, and fixation procedures to prevent recurrence. This reinforces the need for early recognition to prevent ischemia and resection. Conclusion: Prompt recognition of foramen of Winslow hernia on CT enables timely surgery, often avoiding bowel resection. Awareness of this rare entity and its imaging characteristics facilitates early diagnosis and optimal patient outcomes. Fixation procedures such as colopexy or cecopexy may also help prevent recurrence and improve long-term outcomes.