A 52-year-old woman with unremarkable medical and surgical history presented to the emergency department with intermittent abdominal pain. Physical examinations revealed a soft abdomen with epigastric tenderness without signs of peritonitis. A gently uplifting mass from above the pubis to below the umbilicus was palpated. The patient’s white blood cell count was slightly increased to 12,220 cells/μL (normal value: 4000–8000 cells/μL), and other serum tests (e.g., C-reactive protein and liver enzymes) were within respective reference ranges. Abdominal contrast-enhanced CT showed the presence of large uterine fibroids in the pelvis and herniation of dilated small bowel loops between the portal vein and the inferior vena cava (Fig. ).\nNo signs of bowel ischemia or peritonitis were observed. Because abdominal pain was refractory to previously administered medications, we performed elective laparoscopic surgery after bowel decompression using a long intestinal tube on the 19th day of hospitalization.\nLaparoscopic surgery was performed using a 12-mm umbilical port and four 5-mm working ports in the bilateral epigastric and hypogastric regions (Figs. .and ). We observed that the small bowel herniated through the foramen of Winslow. Hernia reduction could not be performed simply by pulling out the herniated bowel because of the adhesion between the herniated bowel and intra-omental tissue. Hence, we incised the lesser omentum to open the lesser sac and facilitate adhesiolysis.\nBecause the herniated bowel was observed to be viable, bowel resection was not performed. No intestinal malrotation or long bowel mesentery was observed, and closure of the foramen of Winslow was not performed. Nevertheless, there were no postoperative complications and the patient was discharged on postoperative day 6. No recurrences have occurred after 12 months of follow-up.
A 42-year-old woman with no relevant medical history, presented at the Emergency Department\nwith epigastric pain, of sudden beginning and progressive worsening, with a few hours of\nevolution. Mild abdominal distension and pain on palpation were noted, but there were no\nsigns of peritoneal irritation. An increase of pancreatic enzymes (amylase: 201 U/L and\nlipase: 880 U/L) was observed and recorded as abnormal finding. As there was diagnostic\nuncertainty and no obvious cause for acute pancreatitis, an abdominal-pelvic CT was\nperformed. It reported the presence of an interposition of the transverse colon between the\nleft lobe of the liver and the stomach, probably related to a foramen of Winslow hernia.\nThere was no pneumoperitoneum. Only a small quantity of free liquid was observed.\nThe patient was submitted to an urgent diagnostic laparoscopy to confirm the imaging\nfindings. The reduction of the hernia contents and the closure of the foramen were carried\nout. There was no need for bowel resection, since there was appropriate viability of the\ncolon (Figs –).\nThe postoperative care progressed favorably without complications. The diet was started on\nthe first postoperative day, being the intestinal transit restored. The patient was\ndischarged on the third day after surgery. After 15 months of follow-up, the patient was\nasymptomatic and there was no evidence of recurrence.