The beak sign of foramen of Winslow hernia
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CLASSICS IN ABDOMINAL RADIOLOGY
The beak sign of foramen of Winslow hernia Frank Chen1 · Shweta Bhatt1 Received: 21 September 2020 / Revised: 8 November 2020 / Accepted: 18 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
The beak sign is a sign that can be seen with foramen of Winslow hernias on computed tomography [1]. The sign refers to the appearance of herniated viscera within the lesser sac that has a tapered, narrowed configuration directed toward the foramen of Winslow, reminiscent of a beak (Fig. 1). Besides the beak sign (Fig. 2a, b), additional computed tomography findings of foramen of Winslow hernias include an air–fluid collection within the lesser sac (Fig. 2c), stretched mesentery and vessels located anterior to the inferior vena cava and posterior to the main portal vein, absence of the cecum and ascending colon in the right gutter, and anterolateral gastric displacement [2]. Foramen of Winslow hernia, a type of lesser sac hernia, accounts for approximately 8% of all internal hernias and is considered a congenital hernia as the foramen is a normal anatomic structure. Risk factors that increase the risk of visceral herniation through the foramen of Winslow include an abnormally enlarged foramen; an elongated right hepatic lobe (Riedel’s lobe); and a hypermobile bowel due to an unusually long small bowel mesentery, the persistence of the ascending mesocolon or intestinal malrotation [3]. Approximately, two-thirds of cases involve herniation of only the small bowel through the foramen with one-third of cases also involving the terminal ileum, cecum and
Fig. 1 Picture of beakers, which have small tapered spouts (beaks) that aid in pouring
ascending colon and rarely the gallbladder, transverse colon, and omentum [4]. Patients with foramen of Winslow hernias normally present with acute, severe, progressively worsening abdominal pain with nausea and vomiting due to small bowel obstruction and less commonly with signs of gastric outlet obstruction, which occurs when the herniated viscera obstructs the stomach [5].
* Shweta Bhatt [email protected] 1
Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
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Abdominal Radiology ▸
Fig. 2 a Axial CT—Cecum (curved white arrow) and terminal ileum (curved yellow arrow) located within the lesser sac with narrowed, tapered configuration directed toward the foramen of Winslow, consistent with bird beak sign (white arrow). Stomach (yellow arrow). b Coronal CT—Cecum (curved white arrow) and appendix (black arrow) located within the lesser sac with narrowed, tapered configuration of terminal ileum (white arrow) directed toward the foramen of Winslow. Stomach (yellow arrow) and pancreas (white star). c Axial CT—More superior image demonstrating cecum (curved white arrow) and appendix (black arrow) within the lesser sac. Stomach (yellow arrow)
Compliance with ethical standards Conflict of interest All authors, Frank Chen and Shweta Bhatt, declare that they have
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