TY - JOUR T1 - Management of an internal hernia through the foramen of Winslow JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2022-000960 VL - 7 IS - 1 SP - e000960 AU - Ashley Lauren Titan AU - Joseph M Garagliano AU - David Spain Y1 - 2022/06/01 UR - http://tsaco.bmj.com/content/7/1/e000960.abstract N2 - A middle-aged woman with a history of right breast lobular carcinoma in situ who underwent bilateral mastectomy in 2000 and implant revision on March 3, 2022 presented to our hospital after 4 hours of postprandial nausea and vomiting. Specifically, she developed sudden-onset nausea and high-volume, non-bloody, non-bilious emesis after eating dinner. She also had obstipation and worsening abdominal distention. Her labs were significant for a white cell count of 13.8 x109/L. Her CT scan demonstrated dilated loops of proximal to mid-small bowel measuring up to 2.9 cm. A loop of bowel was identified to be extending into the lesser sac through the foramen of Winslow, and there was an abrupt transition point as the small bowel entered and exited the foramen of Winslow (figure 1A,B). These findings were concerning for an internal hernia through the foramen of Winslow (figure 2).Figure 1 (A) Axial section through the upper abdomen showing the dilated small bowel. (B) Coronal section demonstrating the dilated small … ER -