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Anatomy, Abdomen, Foramen of Winslow (Omental, Epiploic) Cite this Page

James M. Thomas; Kelly Van Fossen.

Author Information In this Page

Last Update: February 9, 2018. Introduction

Embryology
Introduction Go to:
Surgical Considerations
The foramen of Winslow is an oddity for the anatomist. The foramen of Winslow is
Clinical Significance
defined superiorly by the caudate lobe of the liver and dorsally by the inferior vena cava. The
inferior portion is defined by the duodenum, with the hepatoduodenal ligament serving as the Other Issues

ventral border. The foramen of Winslow is the only natural communication between the greater Questions
peritoneal cavity and the lesser sac. Also known as the epiploic foramen or the omental References
foramen, this small window was described by Jacob Winslow in his 1732 publication,
Exposition anatomique de la structure du corps humain. Born in Denmark, Winslow
converted to Catholicism and became a naturalized French citizen. Along with William Related information
Cheselden in London and Alexander Monro in Edinburgh, Winslow is considered among the PMC
preeminent anatomists of his day. His publication is considered unique, in that it was based PubMed
entirely on his objective observations and did not rely on the opinions of other anatomists. He
eventually became a professor of anatomy at the prestigious Jardin du Roi in Paris. Furthermore,
he was the first to describe the foramen spinosum at the base of the skull. Similar articles in PubMed
Jacob B. Winslow (1669-1760).
Embryology Go to: [Clin Anat. 2012]

A brief review of embryology will assist greatly in the understanding of the formation of the lesser Winslow's contribution to our understanding of the
cervical portion of the sympathetic
[J Hist nervous
Neurosci. 1996]
sac as well as the foramen of Winslow. The embryonic foregut is suspended from the abdominal
wall by both a ventral and dorsal mesentery. The liver forms within the ventral mesentery. The Anatomy of the vestibule of the omental bursa and
epiploic foramen in the horse. [Equine Vet J. 2015]
portion of the ventral mesentery between liver and abdominal wall persists in the mature fetus as
the falciform ligament, and the portion of ventral mesentery between stomach and liver persists in Review Human liver caudate lobe and liver
segment. [Anat Sci Int. 2002]
the mature fetus as the lesser omentum. The lesser omentum includes the hepatogastric and
hepatoduodenal ligaments. That portion of dorsal mesentery attached to the stomach persists in Review [Echographic anatomy of the greater
peritoneal cavity and its recesses].
[Radiol Med. 1988]
the mature fetus as the greater omentum. With the first 90 degrees of intestinal rotation, the
stomach comes to lie on its right side, bringing with it the lesser omentum. Thus the right side of See reviews...
the stomach and the lesser omentum come to lie against the posterior abdominal wall but do not See all...
fuse with it. The space posterior to the stomach becomes the lesser sac. The midgut then rotates
counterclockwise an additional 180 degrees, pivoting around the axis of the superior mesenteric
Recent Activity
artery. In the process, the third portion of the duodenum is draped transversely across the
Turn Off Clear
peritoneal cavity, from right to left, posterior to the superior mesenteric artery. This portion of the
Anatomy, Abdomen, Foramen of Winslow
duodenum, along with the pancreas, becomes secondarily retroperitoneal and forms the (Omental, Epiploic) - StatPearls
posterior wall of the lesser sac. The transverse colon is similarly draped transversely across the
peritoneal cavity but lies anterior to the superior mesenteric artery. The greater omentum then See more...

becomes attached to the transverse colon, and the separation of lesser sac from the greater
peritoneal cavity becomes complete except for the small window at the free distal margin of the
hepatoduodenal ligament, the foramen of Winslow.

Surgical Considerations Go to:

While locating the foramen of Winslow and viable tissue in the operating room is quite simple,
finding it in stiff, non-pliable fixed tissue in the dissecting laboratory can be quite difficult. To find
the foramen of Winslow, a physician can begin at the hepatogastric ligament and follow the lesser
curvature of the stomach distally to the pylorus, at which point the lesser omentum is known as
the hepatoduodenal ligament. They then follow the duodenum distally until the termination of the
hepatoduodenal ligament, then the finger can be slipped around the edge of the hepatoduodenal
ligament and into the foramen of Winslow. The physician then follows the cystic duct to its
junction with the common hepatic duct, then follow the course of the common bile duct within
the hepatoduodenal ligament at which point they are within the foramen of Winslow. Finally, they
take down the hepatic flexure of the colon, then follow the second portion of the duodenum
proximally until they reach the first portion of the duodenum which is the inferior wall of the
foramen of Winslow.

Clinical Significance Go to:

The clinical significance of Winslow’s foramen is 2-fold. First, it serves as a site for an internal
hernia. Hernias in the foramen of Winslow are exceedingly uncommon. As with most internal
hernias, the presenting symptoms are non-specific and are generally those of intermittent bowel
obstruction. Prior to the advent of modern imaging techniques, the diagnosis was frequently
made only at laparotomy, and the delay in diagnosis led to significant mortality. CT scans now
help with the diagnosis, and treatment consists of reduction of the hernia, with or without
resection depending on the viability of the herniated viscera. Laparoscopic repair has been
described as well.

More importantly, because the hepatic artery and portal vein, as well as the common bile duct,
pass through the hepatoduodenal ligament immediately adjacent to the foramen of Winslow,
rapid access to the blood supply to the liver can be obtained in the event of uncontrolled hepatic
bleeding. With the forefinger inserted through the foramen, the vessels can be pinched off
between thumb and finger. For more stability, one jaw of a vascular clamp can be inserted into
the foramen, allowing for clamping off the hepatic artery and portal vein. Both of these
techniques are variations of what is commonly called the “Pringle maneuver,” first described by
surgeon James Hogarth Pringle in 1908. Pringle was born in Australia, of Scottish descent. His
father was a famous surgeon and a contemporary of Joseph Lister. James Pringle emigrated to
Scotland to attend medical school at the University of Edinburg and eventually was appointed
surgeon at the Royal Infirmary of Glasgow in1896. He was well known for his expertise in the
treatment of fractures and other injuries and radical amputations even before his 1908
publication of Notes on the Arrest of Hepatic Hemorrhage due to Trauma. He was known
as a pioneer in trauma surgery.

Other Issues Go to:

Thus, the foramen of Winslow is an oddity for the anatomist, a phenomenon easily explained and
easily understood by the embryologist, a source of rare consternation and occasional great relief
to the surgeon, and for the student in the dissection lab, a treasure to be found at the end of what
can be a long and frustrating search.

Questions Go to:

To access free multiple choice questions on this topic, click here.

Figure

Foramen of Winslow. Bing Image Search Foramen of

Winslow

References Go to:

1. Senati E, Rizzo M, Crescenzi U, Barioglio A. [Herniation of the cecum and ascending colon
through Winslow's foramen and the lesser omentum. A case report]. Ann Ital Chir. 1994
Sep-Oct;65(5):575-7; discussion 578. [PubMed]
2. Valenziano CP, Howard WB, Criado FJ. Hernia through the foramen of Winslow: a
complication of cholecystectomy. A case report. Am Surg. 1987 May;53(5):254-7.
[PubMed]
3. Puig CA, Lillegard JB, Fisher JE, Schiller HJ. Hernia of cecum and ascending colon through
the foramen of Winslow. Int J Surg Case Rep. 2013;4(10):879-81. [PMC free article]
 [PubMed]
4. Pringle JH. V. Notes on the Arrest of Hepatic Hemorrhage Due to Trauma. Ann. Surg.
1908 Oct;48(4):541-9. [PMC free article] [PubMed]

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