Presentation
Abdominal pain. History of previous abdominal surgery.
Patient Data
Caecum is mildly distended and malpositioned in the central upper abdomen and herniated through the foramen of Winslow (together with the terminal ileum), lying in between the pancreas and stomach, with the stomach draped anteriorly over the caecum. No volvulus. There is faecalisation of the distal ileum. Appendix is normal.
The portal vein and common hepatic artery pass below the caecum and are distorted as a result. Portal vein is noted as a thin stretched vessel at this point, and new periportal oedema is noted. No evidence of portal vein thrombosis.
Findings suggestive of rectal prolapse. The remainder of the bowel is unremarkable, with no bowel obstruction. No free intraperitoneal fluid or gas.
Liver, spleen, adrenal glands, pancreas, and kidneys are otherwise unremarkable.
Case Discussion
Features are those of an unfixed caecum that has herniated superiorly through the foramen of Winslow into the lesser sac.
Lesser sac hernias (foramen of Winslow hernia) are a type of abdominal internal hernia.