Presentation
Left sided pain abdomen.
Patient Data
Abnormal crowding and encapsulation of small bowel loops in the left paraduodenal space occupying the left anterior renal space and lumbar region. There is evidence of prominent jejunal loops and stretching of mesenteric vessels within the encapsulated hernial sac. 2nd and 3rd parts of the duodenum are prominent with non-visualization of the 4th part of duodenum. Inferior mesenteric and left colic vessels lie at the anteromedial aspect of the herniated sac. There is a left anterolateral displacement of the descending colon. No evidence of significant small bowel obstruction is noted.
Fatty liver is noted. The rest of the study is unremarkable.
Case Discussion
Paraduodenal hernias are one of the most frequently encountered internal hernias.
This case demonstrates the typical features of an encapsulated left paraduodenal hernia through the fossa of Landzert behind descending colon mesentery.
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