A Cecum Volvulus Herniating Through the Foramen of Winslow After Roux-en-Y Gastric Bypass: A Case Report

Background: Internal herniation (IH) after gastric bypass surgery is a well-known complication. However, an IH through the foramen of Winslow has never been reported previously. Such herniations, most likely due to pre-existing conditions, combined with gastric bypass surgery and rapid weight loss demand adequate assessment. Although the incidence of "traditional" IHs has decreased since primary closure of these defects during initial bariatric surgery, rare types of IHs can still arise. Methods and Results: We report a case in whom a cecum volvulus due to malrotation herniated through the foramen of Winslow 14 months after gastric bypass surgery. In our case, radiological computed tomography examination indicated the possibility of a colic IH. Conclusions: We hypothesize that rapid weight loss and pre-existing conditions, such as a dolichocolon or malrotation, could predispose patients to these "unusual" types of IH. Although there is no other literature describing this phenomenon, we believe that "unusual" types of IH due to rapid weight loss are theoretically more common than previously thought and awareness is advised.