Transcript: Foramen of Winslow Hernia: A Rare Cause of Small Bowel Obstruction

Alex: Welcome to another episode of ResearchPod. Sam, I came across this case report about a man with severe stomach pain that turned out to be something quite unusual—what caught your eye about it?

Sam: This is a case report from researchers at Lancet General Hospital in Ethiopia. It details a 33-year-old man who arrived at the emergency room with sudden abdominal pain, repeated vomiting, and no bowel movements or gas for three days. The central puzzle was a small bowel obstruction with no obvious cause like prior surgery. A CT scan spotted a rare internal hernia through the foramen of Winslow—a natural opening—before surgery. That allowed early repair and removal of dead bowel.

Alex: So the blockage hid inside, with no external clues? What made the bowels get trapped there?

Sam: Yes. A small bowel obstruction blocks the tube-like small intestine, where most digestion happens. Here, loops of small intestine slipped through a tiny natural hole in the abdominal wall into a pocket behind the stomach. Think of it like a garden hose snagging through a gap in a fence—you can't see it from outside, but it kinks and stops the flow.

Alex: That makes sense for why it's hard to spot. Walk me through this foramen of Winslow—why does it trap bowel like that?

Sam: The foramen of Winslow is a small natural doorway, about the size of a finger. It connects the main abdominal space to the lesser sac, a pocket behind the stomach. Normally, belly pressure keeps intestines out. But here, a section called the jejunum slipped in, twisted, and cut off its blood supply—like a rope getting jammed in a pulley, swelling upstream and starving downstream.

Alex: So the CT showed exactly where it was pinched, before the tissue died?

Sam: Right. The patient had a tender belly with no gut sounds and high white blood cells, hinting at inflammation. The urgent CT—with dye for clear views—revealed swollen bowel loops clustered in the lesser sac. Vessels stretched toward the foramen like a bird's beak, with early signs of poor blood flow such as wall thickening.

Alex: That bird's beak sign pointed to the exact spot. What did surgery reveal?

Sam: Surgeons opened the abdomen down the middle. They found about 40 centimeters of mid-jejunum fully dead from lack of blood. They drained bloody fluid, freed the bowel, cut out the dead section, joined the healthy ends, and stitched the foramen shut. The patient ate by day three and went home by day six.

Alex: Even in a resource-limited hospital, CT turned a potential surprise into a targeted fix. Why is this spot so risky?

Sam: It's near major vessels to the liver and the big vein returning blood to the heart. Bowel slipping in can squeeze those or itself, cutting blood flow faster than in other spots. This case had no prior surgery—just likely loose bowel attachments or pressure shifts, common in adults 20 to 60.