Case 33 : Quiz Abdomen
 
11year old with abdominal migraine and cyclical vomitting, USG shows retrogastric nodule
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Diagnosis:
Internal Hernia of transverse colon through foramen of winslow


Discussion:

first data set showed nodule but showed eccentric air

second run was performed after rectal contrast - It showed contrast filled transverse colon in lesser sac

Internal bowel herniations are uncommon and represent possibly only 1% of all hernias. Herniation of bowel into the foramen of Winslow represents only 8% of these (0.08% of all), exceeded in rarity only by herniation of the gallbladder into the lesser sac. The underlying cause of bowel herniation into the lesser sac relates to lack of fusion of the cecum and ascending colon to the posterior abdominal wall, a longer than normal and mobile common mesentery, and a large foramen of Winslow.

CT diagnosis of herniation through the foramen have been reported. CT scanning is now more often the next procedure performed after initial conventional radiography.The CT diagnosis is established by the presence of bowel posterior to the stomach, which is characteristically displaced to the left.

 

Dr Hemant Telkar
Jupiter Scan Centre, Mumbai