Awad, Abanoub

Abstract Foramen of Winslow hernia is a rare subtype of internal hernias, accounting for ⁓8% of all internal hernia cases. Its nonspecific clinical presentation often delays diagnosis, with ˂10% identified preoperatively. With advances in minimally invasive techniques, robotic-assisted surgery has emerged as a safe and precise method for managing complex intra-abdominal pathology. A 70-year-old male presented with an acute abdomen. He was hemodynamically stable, and computed tomography imaging suggested an internal hernia. Robotic-assisted abdominal exploration revealed a segment of colon herniated through the foramen of Winslow. The colon was carefully reduced without complications. A piece of omentum was placed into the defect, and the retracted gall bladder naturally positioned itself within the foramen, potentially minimizing the risk of recurrence. The patient recovered uneventfully and discharged on postoperative day one. To our knowledge, this is the first documented case of foramen of Winslow hernia repair using a robotic-assisted approach.

Abstract Rectus sheath hematoma is a rare condition caused by bleeding from the epigastric arteries, with an incidence of 1.2–1.5 cases per year. We present a 49-year-old male with a smoking history and recent corona virus disease 2019 (COVID-19) infection who presented with symptoms of an upper respiratory infection and suspected venous thromboembolism. Imaging revealed bilateral pulmonary emboli and a left rectus sheath hematoma, which was initially managed conservatively. However, the patient’s condition worsened with a significant drop in hemoglobin and development of encephalopathy. Imaging showed an enlarging hematoma, leading to transfusion and selective embolization. On day 8, the patient developed generalized abdominal pain, and imaging confirmed a hollow viscus perforation. An exploratory laparotomy revealed cecal perforation due to mass effect from the hematoma. An ileocecectomy was performed.