Ostalo

https://doi.org/10.20471/acc.2016.55.01.23

Ileal Herniation Through the Foramen of Winslow: Overeating as A Risk Factor for Internal Herniation

Lora Stanka Kirigin ; Mladen Sekso Department of Endocrinology, Diabetology and Metabolic Diseases, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Marko Nikolić ; Department of Gastroenterology and Hepatology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Ivan Kruljac ; Mladen Sekso Department of Endocrinology, Diabetology and Metabolic Diseases, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Domagoj Marjan ; Department of Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Ivan Penavić ; Department of Abdominal Surgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Neven Ljubičić ; Department of Gastroenterology and Hepatology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Ivan Budimir ; Department of Gastroenterology and Hepatology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Milan Vrkljan ; Mladen Sekso Department of Endocrinology, Diabetology and Metabolic Diseases, Sestre milosrdnice University Hospital Center, Zagreb, Croatia

Sažetak

Internal hernias have an overall incidence of less than 1% and are difficult to diagnose clinically due to their nonspecific presentation. Most internal hernias present as strangulating closed-loop obstruction and delay in surgical intervention is responsible for a high mortality rate (49%). We present a case of ileal herniation through the foramen of Winslow. A 29-year-old previously healthy female presented with acute onset right upper quadrant pain, abdominal fullness, and nausea. The pain was sudden in onset and began shortly after a dinner party where she consumed larger portions of food. Laboratory investigations revealed mild leukocytosis with left shift. Dual-phase multi-detector computed tomography disclosed herniation of the small bowel into the lesser sac. The patient underwent an emergency median laparotomy that revealed ileal herniation through the foramen of Winslow. Adhesiolysis and manual reduction of the bowel was performed, and the reduced bowel showed only congestive changes. The postoperative recovery was uneventful and the patient was discharged on the third postoperative day. Risk factors for internal herniation still remain unclear, although excessively mobile bowel loops and an enlarged foramen of Winslow have been described. Our case demonstrated that overeating could be an additional risk factor for internal herniation. We describe our clinical and radiology findings, as well as surgical management. Due to the high rates of morbidity and mortality, it is imperative that clinicians be aware of the possible risks factors for internal herniation. Internal hernias should be included in the differential diagnosis of small bowel obstruction so that appropriate steps can be made in the work-up of these patients, followed by timely surgical intervention.

Ključne riječi

Abdomen, acute; Hernia, abdominal – surgery; Herniorrhaphy – methods; Ileal diseases – surgery; Hyperphagia; Case reports

Hrčak ID:

161293

URI

https://hrcak.srce.hr/161293

Datum izdavanja:

1.3.2016.

Podaci na drugim jezicima: hrvatski

Posjeta: 2.447 *