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Background <p>Combined internal hernia traversing both the gastrocolic ligament and the foramen of Winslow are exceedingly rare. Their nonspecific clinical features often pose significant diagnostic challenges.</p> Objective <p>To describe the imaging characteristics and surgical management of a rare double internal hernia and emphasize the critical role of computed tomography (CT) imaging in its diagnosis.</p> Case presentation <p>A 61-year-old female presented with symptoms of small bowel obstruction. Contrast-enhanced CT revealed a complex internal hernia with dilated bowel loops within the lesser sac, herniating through the gastrocolic ligament and re-entering the peritoneal cavity via the foramen of Winslow. Additional findings included bowel wall thickening, vascular compression, and ischemic changes, with the “bowtie” sign aiding in diagnosis. Emergency surgical exploration confirmed viable herniated bowel loops and a 2.0&#xa0;cm defect in the gastrocolic ligament.</p> Conclusion <p>This case report highlights the crucial role of CT imaging in diagnosing complex internal hernias. A thorough understanding of abdominal anatomy and recognition of specific imaging signs are essential for early diagnosis and timely surgical intervention, ultimately preventing severe complications.</p>

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CT imaging of a rare combined internal hernia traversing the lesser sac via the gastrocolic ligament and foramen of Winslow

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月12日

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  • Quanxu Ge,
  • Peixia Cong

摘要

Background

Combined internal hernia traversing both the gastrocolic ligament and the foramen of Winslow are exceedingly rare. Their nonspecific clinical features often pose significant diagnostic challenges.

Objective

To describe the imaging characteristics and surgical management of a rare double internal hernia and emphasize the critical role of computed tomography (CT) imaging in its diagnosis.

Case presentation

A 61-year-old female presented with symptoms of small bowel obstruction. Contrast-enhanced CT revealed a complex internal hernia with dilated bowel loops within the lesser sac, herniating through the gastrocolic ligament and re-entering the peritoneal cavity via the foramen of Winslow. Additional findings included bowel wall thickening, vascular compression, and ischemic changes, with the “bowtie” sign aiding in diagnosis. Emergency surgical exploration confirmed viable herniated bowel loops and a 2.0 cm defect in the gastrocolic ligament.

Conclusion

This case report highlights the crucial role of CT imaging in diagnosing complex internal hernias. A thorough understanding of abdominal anatomy and recognition of specific imaging signs are essential for early diagnosis and timely surgical intervention, ultimately preventing severe complications.