We report a rare case of congenital, incarcerated HFW, discussing its diagnosis, management, and surgical strategies along with a literature review.

Case Description A young male with an unremarkable medical history presented with abdominal pain and hematochezia for 5 hours. Abdominal CT showed gastric dilatation, irregular duodenal contour with localized luminal expansion, and air-fluid levels, initially suspicious for a duodenal diverticulum or volvulus with possible obstruction. Treatment Due to progressive pain despite conservative therapy, emergency laparoscopy was performed, revealing an incarcerated ileal HFW with 200 ml ascites, a foramen diameter of 3cm, and herniated ileal segment of 50 cm. Laparoscopic bowel decompression, hernia reduction, and foramen closure with hemostatic gauzeplus medical gluer were successfully executed.

The patient recovered uneventfully with normal bowel function. Follow-up CT was clear, and no recurrence was observed at 6 months.

HFW mimics simple bowel obstruction but progresses rapidly to necrosis, perforation, or sepsis if misdiagnosed. High vigilance regarding specific CT findings and changing abdominal signs is crucial. Early laparoscopic exploration is both diagnostic and therapeutic to prevent necrosis, while individualized foramen closure is key to preventing recurrence.