Ýntestinal obstruksiyona neden oldukça nadir bir durum: Formen winslow herni

Foramen winslow hernisi (FWH) çok nadir görülen ve spesifik muayene bulgularý olmadýðý için taný konulmasý zor olan bir hastalýk olduðu bilinmektedir. Hastalar acil servise ileus tablosu ile baþvurmaktadýr. Tanýda geç kalýnmasý barsak ansýnýn iskemi ve perforasyonuna sebep olabilmektedir. Erken taný konulmasýndaki zorluk bu durumun mortalite ile sonuçlanma ihtimalini artýrmaktadýr. 41 yaþýnda erkek hasta acil servise iki gündür devam eden kolik tarzda karýn aðrýsý ile baþvurdu. Hasta tetkik ve tedavi amacýyla genel cerrahi servisine yatýrýldý. Takiplerinde klinik tabloda rahatlama olmasý üzerine taburcu edildi fakat 2 gün sonra karýn aðrýsýna bulantý ve kusmalarýn eþlik etmesi, gaz-gaita çýkaramama durumunun eklenmesi ile tekrar acil servise baþvurdu. Hastaya yapýlan laboratuar ve görüntüleme incelemeleri sonrasý ameliyat kararý alýndý. Uygulanan laparaskopik incelemede, ileoçekal bileþkeden proksimale doðru ilerlendi ve 220. cm de ince barsak ansýnýn Foramen Winslow’a herniye olduðu görüldü. Herniye barsak ansý redükte edildi. FW açýklýðýna müdahale edilmedi ve operasyon sonlandýrýldý. Foramen winslow hernilerinin nadir görülmesi, ileus nedeniyle acil servise baþvuran hastalarda ön taný olarak düþünülme ihtimalini azaltmaktadýr. Doðustan konjenital anomalileri olan, geçirilmiþ batýn cerrahisi olmayan hastalarda Foramen Winslow Herni ihtimali düþünülebilir. Tanýda en iyi görüntüleme yönteminin Kontrastlý batýn bilgisayarlý tomografi (CT) olup CT’de omentum minusta barsak anslarýnýn görülmesi önemlidir.

An extremely unusual condition that leads to intestinal obstruction: Foramen Winslow hernia

It is known that foramen Winslow hernia (FWH) is a very rare disease and difficult to diagnose because there are no specific examina-tion findings. Patients usually present to the emergency department with an intestinal obstruction. Delay in diagnosis may cause isch-emia and perforation of the intestinal loop. Difficulties in early diagnosis increase the probability of this condition resulting in mortality. A 41-year-old male patient was admitted to the emergency department with colic abdominal pain lasting for 2 days. The patient was hospitalized for further examination and treatment. Due to the improvement in his clinical state, the patient was discharged; however, 2 days later, he was readmitted to the emergency department with an inability to pass stool or flatus, nausea, and vomiting, as well as abdominal pain. After laboratory tests and imaging methods were applied to the patient, surgery was decided upon. In the laparoscopic examination, it was observed that the small bowel loop herniated into the foramen Winslow (FW) at 220 cm proximally from the ileocecal junction. Herniated bowel loops were reduced. The open FW was not intervened in, and the operation was terminated. Due to their rarity, FWHs are less likely to be considered a preliminary diagnosis in individuals who present to the emergency department with intestinal obstruction. FWH may be considered in patients with congenital anomalies and without previous abdominal surgery. The best imaging technique for diagnosis is contrast-enhanced abdominal computed tomography (CT), and it is critical to recognize bowel loops in the omentum minus on CT.