The epiploic foramen (foramen of Winslow) connects the greater and lesser peritoneal sacs. Which structure forms its inferior boundary, and what is the clinical consequence of obstructing it?

• A The hepatoduodenal ligament forms the anterior boundary; obstruction causes portal hypertension
• B The first part of the duodenum (D1) forms the inferior boundary; obstruction by a Winslow hernia traps bowel in the lesser sac causing acute intestinal obstruction ✓
• C The caudate lobe of the liver forms the posterior boundary; obstruction causes hepatic venous congestion
• D The inferior vena cava forms the posterior boundary; obstruction causes Budd-Chiari syndrome

Explanation

The epiploic foramen of Winslow has four boundaries: anteriorly — hepatoduodenal ligament (containing portal vein, hepatic artery, bile duct); posteriorly — inferior vena cava; superiorly — caudate lobe of liver; inferiorly — first part of duodenum (D1) and hepatoduodenal ligament. A Winslow hernia occurs when bowel herniates through the foramen into the lesser sac, causing acute intestinal obstruction. Manual compression of the hepatoduodenal ligament (Pringle's manoeuvre) controls hepatic inflow during liver surgery. The foramen is clinically important in understanding lesser sac collections (e.g., pancreatic pseudocyst).

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.