# Laparoscopic Management of a Rare Lesser Sac Internal Hernia Involving the Terminal Ileum and Entire Right Colon: A Diagnostic and Surgical Challenge

## TL;DR

This paper describes a rare case of a complex internal hernia managed successfully through laparoscopic surgery.

## Contribution

The novelty lies in the laparoscopic management of a rare internal hernia involving multiple intestinal segments.

## Key findings

- A rare internal hernia involving the terminal ileum and right colon was diagnosed using CT imaging.
- Laparoscopic surgery was successfully used to manage this complex hernia.
- The case highlights the surgical challenges and techniques involved in such rare presentations.

## Abstract

Internal hernias are an uncommon cause of bowel obstruction. The diagnosis and identification of the cause of internal herniation can be challenging, but modern imaging, particularly CT scan, facilitates preoperative identification. The foramen of Winslow hernia represents a rare subtype, accounting for a small fraction of all internal hernias and often presenting with non-specific symptoms. Most reported cases in the literature were managed through open surgery, albeit a few favored laparoscopy. This report presents a challenging case involving herniation of the terminal ileum, cecum, and ascending and transverse colon through the foramen of Winslow. We share the successful laparoscopic management, highlighting the surgical challenges and techniques used in this rare presentation.