Unusual type of left paraduodenal hernia caused by a separated peritoneal membrane

Abstract

Internal hernias are an uncommon cause of intestinal obstruction, with left paraduodenal hernia being the most frequent of these. Computed tomography (CT) with contrast media is advantageous for the clinical workup of suspected paraduodenal hernias. Here, we report a case of an unusual paraduodenal sac formed by a peritoneal membrane between the transverse and the descending colon, which entrapped the proximal jejunum, causing intestinal obstruction. Preoperative CT demonstrated a cluster of jejunal loops between the stomach and pancreas, and showed that the inferior mesenteric vein was laterally displaced.

A paraduodenal hernia (Treitz's hernia) causing acute bowel obstruction

“…Paraduodenal hernias constitute half of all internal abdominal hernias and occur when the small bowel herniates into the paraduodenal fossa with manifestation of intestinal obstruction (2). Specific clinical signs are often absent, leading to the frequent delay of correct diagnosis, with bowel necrosis resulting in up to 20% of patients (3). Herein, we present our case to increase the awareness of Treitz's hernia and suggest the early CT scan intervention may be helpful to make the preoperative diagnosis of paraduodenal hernia.…”

Review of Internal Hernias: Radiographic and Clinical Findings

“…Mild duodenal dilatation often occurs, and the efferent loop often shows an abrupt caliber change [5]. With CT, similar findings of encapsulated bowel loops are noted, either at the duodenojejunal junction between the stomach and pancreas to the left of the ligament of Treitz; behind the pancreatic tail itself, displacing the inferior mesenteric vein to the left; or between the transverse colon and the left adrenal gland [5][6][7][9][10][11][12] (Figs. 4A-4D).…”

“…The 5% refers to the incidence after Roux loops used during surgery for reasons other than liver transplantation or gastric bypass. trunks, especially the inferior mesenteric vein, to the left, are also helpful findings [10,11]. If the vasculature is optimally visualized, one can often see additional findings of engorged vessels grouped together at the entrance of the hernia sac, with the proximal jejunal arteries showing an abrupt change of direction posteriorly behind the inferior mesenteric artery [6,7] (Fig.…”

Right paraduodenal hernia leading to bowel strangulation

“…For a left paraduodenal hernia, careful traction on the small bowel assists in reducing the hernia contents; the peritoneal edges can then be sutured to the mesentery to widely open the defect. For both types of hernia, it is crucial to take care to avoid injuring the mesenteric vessels, namely, the SMA with the right paraduodenal hernia and the inferior mesenteric vein with the left paraduodenal hernia [6]. Having a high index of suspicion for this disease entity is important because the rate of bowel necrosis can be as high as 20% [7].…”