Buisset Cyrille, Postillon Agathe, Aziz Sandrine, Bilbault Florian, Hoch Guillaume, Nesseler Jean-Philippe, Johann Marc
Department of Digestive, Endocrine and Metabolic Surgery, Hôpital Robert Schuman - Hôpitaux Privés de Metz, Metz, France.
Department of Digestive, Hepato-Biliary and Endocrine Surgery, University Hospital of Nancy, Vandoeuvre-les-Nancy, France.
J Surg Case Rep. 2020 Sep 8;2020(9):rjaa283. doi: 10.1093/jscr/rjaa283. eCollection 2020 Sep.
Herniation through the foramen of Winslow is rare, with a non-specific clinical presentation and his diagnosis may be difficult. A 44-year-old female was admitted with an acute epigastric abdominal pain. A computed tomography showed an internal hernia of the colon in the lesser sac. Laparoscopic reduction of the herniated contents and the fixation of the ascending colon with several non-absorbable sutures were performed. Twenty months after surgery, the patient has not experienced any recurrence. Computed tomography helps practitioners to the preoperative diagnosis of herniation through the foramen of Winslow, to the viability of the herniated contents and presence of occlusion. In case of herniation through the foramen of Winslow favored by a mobile ascending colon with a misapposition of the right Told fascia, the fixation of the colon with a non-absorbable suture was safe and may prevent the risk of recurrent internal hernia and colonic volvulus.
通过网膜孔的疝出很少见,临床表现不具特异性,其诊断可能困难。一名44岁女性因急性上腹部腹痛入院。计算机断层扫描显示小网膜囊内有结肠内疝。进行了腹腔镜下疝内容物还纳及用数根不可吸收缝线固定升结肠。术后20个月,患者未出现任何复发。计算机断层扫描有助于医生对通过网膜孔的疝出进行术前诊断,判断疝内容物的活力及有无梗阻。对于因活动度大的升结肠伴右侧Toldt筋膜错位而导致的通过网膜孔的疝出,用不可吸收缝线固定结肠是安全的,且可预防复发性内疝和结肠扭转的风险。