Lesser sac hernia

Internal
hernia through the foramen of Winslow. Abdominal radiograph shows a gas-containing colonic segment in the centre of the upper abdomen between the liver and the gastric air bubble.
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Internal
hernia through the foramen of Winslow. Axial image depicting the dilated caecum (C) in the lesser sac between the stomach (S) anteriorly and the pancreas (P) posteriorly.
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Internal
hernia through the foramen of Winslow. CT axial image illustrating the caecum in the lesser sac and the terminal ileum (I) passing through the foramen of Winslow.
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Internal
hernia through the foramen of Winslow. CT axial image illustrating the caecum in the lesser sac and the ascending colon (AC) passing through the foramen of Winslow.
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Internal
hernia through the foramen of Winslow. The foramen of Winslow (FW) is located behind the hepaticoduodenal ligment (HDL) - contains the portal vein, proper hepatic artery and common bile duct. The inferior vena cava (IVC) forms its posterior border.
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Internal
hernia through the foramen of Winslow. CT oblique reconstruction depicting the terminal ileum (I) and the ascending colon (AS) passing through the foramen of Winslow. The caecum is located in the lesser sac.
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Internal
hernia through the foramen of Winslow. CT oblique reconstruction illustrating the foramen of Winslow, located behind the hepatoduodenal ligament (HDL). Its posterior, superior, and inferior boundaries include the inferior vena cava (IVC), caudate lobe (HCL), and duodenum (D), respectively.
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Lesser sac hernias (alternative plural: herniae) are a type of internal hernia, where abdominal contents protrude through the foramen of Winslow, hence they are also known as foramen of Winslow hernia.

Epidemiology

Lesser sac hernias are rare, accounting for <0.1% of abdominal hernias and 8% of internal hernias .

Risk factors

Pathology

Typically contains small bowel only (~67%) but may also contain cecum/ascending colon and less commonly transverse colon, gallbladder, or omentum.

Radiographic features

Plain radiograph
  • gas-filled loops of small bowel in the upper abdomen
CT
  • mesenteric fat/vessels posterior to portal vein, common bile duct, hepatic artery and anterior to the inferior vena cava
  • mesenteric vessels passing into the lesser sac via the foramen of Winslow
  • gas and/or fluid in the lesser sac with bird beak sign towards the foramen of Winslow
  • abnormal cecal position

Differential diagnosis

History and Etymology

It is named after Jacques Benigne Winslow (1669-1760), a Danish-born French anatomist.

Siehe auch:
Assoziationen und Differentialdiagnosen zu innere Hernie durch das Foramen epiploicum:
innere
Hernien
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