Rare cause of acute pain in the left upper abdominal quadrant

We report a case of a 45-year-old man with acute pain in the left upper abdominal quadrant. Extensive diagnostic workup remained inconclusive. An exploratory laparotomy revealed herniation of the entire ascending colon, together with a part of the terminal ileum through the foramen of Winslow into the bursa omentalis. The internal hernia was further complicated by a perforated appendicitis within the bursa, explaining the acuteness of the symptoms. Reduction of the hernia, appendectomy and colopexy were performed consequently. This would be the first reported case of a perforated appendicitis within the lesser sack.