A 44-year-old female patient, without prior abdominal surgery, was admitted to the emergency department with an acute epigastric abdominal pain, without nausea. She presented similar episodes of pain in the past, without having ever requested a medical opinion. Physical examination revealed an acute epigastric pain without signs of peritonitis. Laboratory analyses were within normal limits. A computed tomography showed an internal hernia of the colon in the lesser sac, going back from the liver pedicle (). There were neither occlusion nor ischemia. We performed immediately a diagnostic laparoscopy with one 11-mm umbilical port and two 5-mm ports (one in the left lumbar and one in the hypogastrium). Exploration confirmed that the ascending colon and the right colonic flexure had herniated through the foramen of Winslow (). The colon was reduced with an atraumatic Johann’s graspers and was viable, cecum, ascending colon and the right colonic flexure was mobile due to a misapposition of the right Told fascia. To prevent recurrent herniation we performed the fixation to the lateral wall of the cecum, ascending colon and right colonic flexure with several non-absorbable sutures (). We did not perform the closure of the Winslow’s hiatus. Postoperatively, the patient recovery was uneventful and was discharged home 2 days later. A computed tomography was performed 1 month later for another reason, showing a good result of the right colon fixation on the lateral wall (). Twenty months after surgery, the patient totally recovered and has not experienced any recurrence or occlusion.
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.