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Case report


A Rare Cause of Obstructive Jaundice: Cecal Herniation through the Foramen of Winslow.

Ivan WelaratneAfshin Nasoodi
Department of Radiology, St James’s Hospital, Dublin, Ireland
Date of Submission: 18-Feb-2018, Date of Acceptance: 11-May-2018, Date of Web Publication: 18-Jun-2018.
Corresponding Author:
Corresponding Author

Ivan Welaratne

Apartment 1, 74 Fitzwilliam Lane, Dublin 2, Ireland.
E-mail: welarati@tcd.ie

Corresponding Author:
Corresponding Author

Ivan Welaratne

Apartment 1, 74 Fitzwilliam Lane, Dublin 2, Ireland.
E-mail: welarati@tcd.ie

DOI: 10.4103/jcis.JCIS_12_18 Facebook Twitter Google Linkedin

ABSTRACT


Internal abdominal hernias are rarely reported in the literature and have a very low rate of preoperative diagnosis. It is even rarer that they present with jaundice. A 59-year-old Caucasian female presented with a short history of jaundice, dark urine, epigastric pain, vomiting, and obstipation. Her liver biochemistry profile revealed a mixed cholestatic/hepatocellular pattern with significantly elevated bilirubin. She urgently underwent abdominal imaging which provided a preoperative diagnosis of internal herniation of the cecum within the lesser sac through the foramen of Winslow. The dilated bowel was compressing the common bile duct explaining the jaundice. This was repaired intraoperatively by anchoring the mobile cecum. In this case, we highlight the importance of maintaining a high index of suspicion for internal herniation on abdominal imaging with clinical evidence of intestinal obstruction. A foramen of Winslow hernia should be further suspected in the presence of jaundice.
Keywords: Computerized tomography, foramen of Winslow, internal hernia, jaundice

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