Strangulated small bowel hernia through the foramen of Winslow: a rare surgical emergency

A rare cause of small bowel obstruction (SBO), an internal hernia via the foramen of Winslow offers a high risk of strangulation because of its delayed identification. We present a 33-year-old male patient who developed gangrenous SBO as a result of incarceration in the lesser sac through the Winslow foramen.

A 33-year-old male presented with acute abdominal pain, vomiting, and obstipation. Imaging revealed dilated small bowel loops and a transition point near the foramen of Winslow. Emergency laparotomy confirmed a hernia with ischemic bowel, necessitating resection and anastomosis. The patient recovered well postoperatively.

Foramen of Winslow hernias (FWH) are exceedingly rare (<0.1% of hernias) and often present with nonspecific symptoms, leading to diagnostic delays. This case underscores the critical role of early imaging, particularly computed tomography (CT), in identifying FWH and preventing catastrophic outcomes like bowel ischemia. Timely surgical intervention is paramount, as delayed treatment can result in significant morbidity or mortality. Clinicians should maintain a high index of suspicion for internal hernias in cases of atypical SBO, even in patients without prior surgical history.

A foramen of Winslow hernia is a surgical emergency that needs to be identified quickly in order to avoid serious consequences. Early imaging and a high level of clinical suspicion are essential.