Herniation through both Winslow's foramen and a lesser omental defect: Report of a case

The herniation of small bowel through Winslow's foramen is a rare type of i nternal hernia which ran cause ileus; however, a hernia traversing the less er sac is even more unusual. To the best of our knowledge, only 25 cases of herniation through Winslow's foramen and 10 cases of lesser sac hernia hav e been reported in the Japanese literature. We describe herein the case of a 33-year-old man who presented to our hospital complaining of abdominal pa in in whom a plain abdominal radiograph revealed small bowel gas with air-f luid levels, suggesting ileus. Following admission, an ileus tube was inser ted, but the intestinal shadow did not improve and surgery was performed ba sed on suspicion of an internal hernia. Approximately 100 cm of ileum was f ound to have herniated through a defect in the lesser omentum after passing through Winslow's foramen, Since the herniated bowel was viable, manual re duction without resection was performed. The patient had a satisfactory pos toperative course, and was discharged on postoperative day 11, There are ma ny unknown aspects surrounding the etiology of Winslow's foramen hernia and lesser sac hernia, and although internal hernia is a rare cause of ileus, its possibility should be kept in mind.