Cecal internal hernia through Winslow's hiatus.

BACKGROUND: Hernia through Winslow's hiatus, known as Blandin's hernia, a rare but potentially life-threatening condition, represents a diagnostic and therapeutic challenge. This case report describes a successful laparoscopic approach to a cecum hernia through the foramen of Winslow in a 63-year-old female. CASE PRESENTATION: The patient presented with 24 hours of abdominal pain and nausea. Abdominal CT scan revealed a herniated cecum and terminal ileum compressing the gastric chamber and portal vein, leading to periportal edema. Laparoscopic right colectomy was performed after successful colon content evacuation via the greater gastric curvature to facilitate reduction. This was done to aid in reduction, as there were indications of non-viability in the right colon. The procedure unfolded without complications. The patient developed postoperative abdominal collections requiring percutaneous drainage but recovered well and was discharged within two weeks. CONCLUSION: This case highlights the value of laparoscopy in managing foramen of Winslow hernias, offering minimally invasive benefits. Early diagnosis through imaging tools like CT is crucial for prompt surgical intervention and preventing complications like intestinal ischemia or perforation.

Antecedentes: La hernia por hiato de Winslow, conocida como hernia de Blandin, una afección rara pero potencialmente mortal, representa un desafío diagnóstico y terapéutico. Este informe de caso describe un abordaje laparoscópico exitoso de una hernia de ciego a través del agujero de Winslow en una mujer de 63 años. Presentación del caso: El paciente presentó dolor abdominal y náuseas de 24 horas de evolución. La tomografía computarizada abdominal reveló una hernia de ciego y íleon terminal que comprimía la cámara gástrica y la vena porta, lo que provocaba edema periportal. La colectomía derecha laparoscópica se realizó después de una evacuación exitosa del contenido del colon a través de la curvatura gástrica mayor para facilitar la reducción. Esto se hizo para ayudar en la reducción, ya que había indicios de inviabilidad en el colon derecho. El procedimiento se desarrolló sin complicaciones. El paciente desarrolló colecciones abdominales posoperatorias que requirieron drenaje percutáneo, pero se recuperó bien y fue dado de alta a las dos semanas. Conclusión: Este caso resalta el valor de la laparoscopia en el manejo del foramen de las hernias de Winslow, ofreciendo beneficios mínimamente invasivos. El diagnóstico temprano mediante herramientas de imagen como la tomografía computarizada es crucial para una intervención quirúrgica rápida y prevenir complicaciones como isquemia intestinal o perforación.

Internal hernia after laparoscopic left colectomy: case series and review of the literature

Objective: Laparoscopic colectomy has gained acceptance as a standard treatment for benign and malignant colorectal disease, such as diverticular disease and cancer, among others. Same as in open surgery, the laparoscopic approach carries a low risk of small bowel obstruction in the postoperative period, but in laparoscopic surgery, internal hernia after laparoscopic left colectomy may be a cause of small bowel obstruction with a significant risk of morbidity and mortality. This rare complication may be prevented with routine closure of the mesenteric defects created during the colectomy. Methods: We present four cases of internal herniation after laparoscopic colectomy. Two cases were after laparoscopic left colectomy and two after laparoscopic low anterior resection. All four cases had full splenic flexure mobilization. Routine closure of the mesenteric defect was not performed in the initial surgery. Results: The four patients were treated by laparoscopic reintervention with closure of the mesenteric defect. In two of them, conversion to open surgery was necessary. One of the patients developed recurrent internal herniation after surgical reintervention with mesenteric closure of the defect. All patients were managed without need for bowel resection, and mortality rate was 0%. Conclusion Internal herniation after laparoscopic colorectal surgery is a highly morbid complication that requires prompt diagnosis and management and should be suspected in the early postoperative period. Additional studies with extended follow-up are required to establish recommendations regarding its prevention and management. (AU)