Epiploic foramen

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ΕΤΥΜΟΛΟΓΙΑ

Adjectival form of epiploön, an old term for omentum. Epiploön (επιπλοον) is a Greek word derived from the verb επιπλεειν, which means to sail or float.

A complicated bit of topology adjacent to the liver, arising from the invagination of the peritoneal cavity by the organs. Also named the foramen of Winslow after the anatomist who described it around 1732.

It is the sole communication between the greater and lesser sacs. One edge of the foramen is composed of the free edge of the lesser omentum. In bleeding from the liver or gall bladder, compression of the is free edge of the lesser omentum, achieved with a finger through the foramen and thumb remaining in the greater sac, can be a temporary measure to control bleeding. This is called the Pringle manoeuvre after James Hogarth Pringle who first described it in 1908.[1]

Herniation

Fairly common in horses

Herniation through the epiploic foramen is a rare internal hernia and easy to miss clinically with the risk of bowel ischaemia and sepsis[2]. This has lead in some series to mortality rates of high mortality rates of around 36–49%[3]. Herniation is more likely in those with anatomical variants that result in:

  • Mobile caecum and ascending colon with long mesentery
  • Elongated right hepatic lobe
  • Large epiploic foramen

References