Internal hernia through the foramen of Winslow is a rare occurrence accounting for less than 0.1% of all abdominal hernias. Approximately 170 cases have been reported since the first description by Blandin in 1834 which have been treated with exploratory laparotomy due to late presentation and presence of bowel ischemia. We present a case of first ever successful laparoscopic reduction of this internal hernia.

A 38 year old female presents to the emergency room with 18 hour history of upper abdominal pain, nausea and repeated emesis. She had at least two similar episodes over the past 6 weeks which resolved spontaneously. Her past surgical history is remarkable for a laparoscopic ovarian dermoid excision and laparoscopic lysis of pelvic adhesions. On examination, the patient's vital signs are within normal limits. There is minimal abdominal distension with no peritoneal signs. A CT scan perfomed shows herniated bowel loops in the lesser sac representing internal hernia through the foramen of Winslow. She is taken to the operating room for exploratory laparoscopy after she failed to improve with conservative measures and was unable to tolerate oral intake.

At laparoscopy right colon including the ceacum was seen herniating into the lesser sac. This was reduced without difficulty with gentle traction and all the large bowel appeared viable. The foramen was then closed with interrupted silk endosutures. The patient tolerated the procedure well and was discharged home on the first post-operative day.