The n e w e ng l a n d j o u r na l of m e dic i n e

images in clinical medicine

Hernia through the Foramen of Winslow

A Terminal ileum B
Foramen of Winslow

Foramen of Winslow
Distal ileum

Pylorus
Jejunum

Duodenum

A 
28-year-old man presented with intolerable epigastric pain Wen Cheng Huang, M.D.
after eating dinner. The pain was sudden in onset and accompanied by bil- Chih-Yuan Fu, M.D.
ious vomiting. The physical examination revealed local tenderness over the Wan Fang Hospital
left upper quadrant of the abdomen, with guarding. Contrast-enhanced computed Taipei Medical University
tomography (CT) showed the terminal ileum (Panels A and B, arrows) herniating Taipei, Taiwan
through the foramen of Winslow. The CT images also revealed that the stomach
was compressed by small bowel loops, with wall thickening. The patient underwent
an emergency laparotomy. Among the internal hernias, the hernia through the fo-
ramen of Winslow is rare and easily overlooked. Delayed diagnosis can result in
ischemic bowel and severe sepsis. Risk factors for foramen of Winslow hernia in-
clude long small-bowel mesentery, a mobile cecum and ascending colon, an elon-
gated right hepatic lobe, and a large foramen of Winslow. In this patient, the
non­viable segment of the bowel was resected and the incarcerated intestine was
reduced. The postoperative period was uncomplicated and uneventful.
DOI: 10.1056/NEJMicm1112142
Copyright © 2012 Massachusetts Medical Society.

n engl j med 367;5  nejm.org  august 2, 2012 e7

The New England Journal of Medicine
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