Foramen of Winslow hernia in a patient with ventriculoperitoneal shunt: A case report and review of literature

Abstract

Introduction: Foramen of Winslow hernias are a rare subset of internal hernias. They are difficult to diagnose clinically. They should be considered by surgeons in the differential diagnosis in patients presenting with abdominal pain. A high index of suspicion and early imaging are necessary for prompt diagnosis and treatment to avoid morbidity and mortality. Case Report: A 73-year-old patient presented to the emergency department with complaints of severe epigastric pain that had significantly reduced by the time of presentation. She had a ventriculoperitoneal shunt for hydrocephalus about four years ago. An urgent multidetector computed tomography scan performed in the emergency department demonstrated an internal hernia, with the cecum herniating through the foramen of Winslow. Emergency surgery was commenced laparoscopically but was converted to laparotomy as the herniated contents could not be reduced laparoscopically. The patient made an uneventful postoperative recovery and was discharged home on the fifth postoperative day. Conclusion: Urgent surgical intervention is necessary in these cases. There is a lack of clear guidelines for abdominal surgery in the presence of a ventriculoperitoneal shunt. A neurosurgical opinion should be sought, preferably before proceeding to surgery. There is debate regarding the specifics of surgical management of these hernias, with a lack of clear guidelines.