A case of spontaneous right colon volvulus with herniation through the foramen of Winslow

S. Epp, J. Chmielewski, C. Apestegui, S. Lionetto

Objective

To present an unusual and interesting case of right colon volvulus with subsequent internal hernia.

Methods

Spontaneous internal hernias are rare, representing between 0.5-8% of the intestinal occlusions. Left paraduodenal hernias are the most common type (40%). Internal hernias through the Foramen of Winslow are a subtype of internal hernias, they represent 8% of internal hernias, and only 0.1% of all abdominal hernias. We present an spontaneous case of right colon volvulus with subsequent herniation through the foramen of Winslow in a young female patient.

Results

A 36 years old woman was admitted in our Urgency Department with acute abdominal pain, nausea and vomiting. At clinical examination, she presented generalized pain, with slightly peritonismus, mainly on the right abdominal flank. Blood values showed a leucocytosis of 20.3. An ultrasound was performed, showing free abdominal fluid. A subsequent CAT Scan reported a spontaneous right colon volvulus with an internal herniation, probably through the foramen of Winslow. An exploratory laparotomy was performed: a right colon volvulus with herniation through the foramen of Winslow has been diagnosed. Due to the ischemic and macroscopic necrotic aspect of the colon, a right colectomy was performed, with an end-to-end manual ileo-tranverse anastomosis. The patient recovered uneventfully, and was discharged 10 days after surgery.

Conclusion

Spontaneous internal hernias are rare, most of them of the paraduodenal type. Hernias through the foramen of Winslow are even rarer. In this particular case, we present an atypical case of right colon volvulus with herniation. Although rare, one should think about the possibility of spontaneous internal hernia, in patients having acute abdominal pain with signs of intestinal occlusion. In these cases, the CAT Scan is the most useful imaging method. Once the diagnosis is made, an emergency surgery is mandatory.

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