Ichikawa Yoshitoshi, Kanazawa Akifumi, Dan Nobuhiro, Ishikawa Satoshi, Hagi Takaomi, Mizojiri Gaku, Tsubakimoto Mituo, Oka Hiroshi
Department of Surgery, Moriguchi Keijinkai Hospital, Moriguchi, Japan.
Department of Radiology, Moriguchi Keijinkai Hospital, Moriguchi, Japan.
Asian J Endosc Surg. 2017 Aug;10(3):328-330. doi: 10.1111/ases.12372. Epub 2017 Jun 22.
A previously healthy 35-year-old man visited the emergency room complaining of epigastric pain and vomiting. The pain was sudden in onset. His blood tests were within normal limits except for a mild neutrophilia of 14 300/μL. Enhanced abdominal CT scan showed the small intestine dilated into the space between the portal vein and inferior vena cava from the foramen of Winslow. Under the diagnosis of herniation through the foramen of Winslow (HFW), we performed emergency laparoscopic surgery. Laparoscopy revealed an internal herniation of the dilated small intestine through the foramen of Winslow. Because the herniated small intestine was viable, intestinal resection was unnecessary. We released the incarceration under laparoscopy. HFW is very rare and often overlooked, but abdominal CT examination enabled a precise preoperative diagnosis because of characteristic findings. We should consider the possibility of HFW in patients with internal herniation of unknown origin. Laparoscopic surgery for HFW is effective.
一名35岁既往健康的男性因上腹部疼痛和呕吐前往急诊室就诊。疼痛突发。除了轻度中性粒细胞增多至14300/μL外，他的血液检查结果均在正常范围内。增强腹部CT扫描显示小肠从温氏孔扩张至门静脉和下腔静脉之间的间隙。在诊断为经温氏孔疝（HFW）后，我们进行了急诊腹腔镜手术。腹腔镜检查发现扩张的小肠经温氏孔发生内疝。由于疝入的小肠仍有活力，无需进行肠切除。我们在腹腔镜下解除了嵌顿。HFW非常罕见且常被忽视，但腹部CT检查因其特征性表现能够进行精确的术前诊断。对于不明原因内疝的患者，我们应考虑HFW的可能性。HFW的腹腔镜手术是有效的。
