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.
Herniation through the epiploic foramen is a rare internal hernia and easy to miss clinically with the risk of bowel ischaemia and sepsis. This has lead in some series to mortality rates of high mortality rates of around 36–49%. 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
- ↑ Pringle JH. Notes on the arrest of hepatic haemorrhage. Annals of Surgery 1908;48:541-549
- ↑ Ray K, Snowden C, Khatri K, McFall M. Gastric outlet obstruction from a caecal volvulus, herniated through epiploic foramen: a case report. BMJ case reports. 2009; 2009:.(Link to article – subscription may be required.)
- ↑ Osvaldt AB, Mossmann DF, Bersch VP, Rohde L. Intestinal obstruction caused by a foramen of Winslow hernia. American journal of surgery. 2008 Aug; 196(2):242-4.(Link to article – subscription may be required.)