Operative Management of Cecal Volvulus Herniating Through the Foramen of Winslow

Abstract

Cecal volvulus is a surgical emergency which is associated with the risk for bowel ischemia and perforation. Occasionally, volvulus can be caused by an internal hernia.We report the case of a 73-year-old woman with no prior surgical history who had abrupt onset abdominal pain, distension, bilious emesis, and obstipation. Computed tomographic imaging showed a twisted, dilated cecum within the lesser sac with the base of the volvulus at the foramen of Winslow and mass effect against a decompressed stomach. In the operating room, the patient underwent exploratory laparotomy, reduction of the cecal volvulus through the lesser sac, and right hemicolectomy with primary ileocolic anastomosis.Given the substantial morbidity and mortality risk if a closed loop obstruction is left untreated, it is of paramount importance to consider internal hernias as a potential cause to allow an early diagnosis and an urgent surgical treatment.