Presentation
On and off severe abdominal pain for 2 days. He had a past history of similar episodes.
Patient Data
A cluster of non-dilated jejunal bowel loops is herniated lateral to the duodenojejunal junction (left of ligament of Treitz) into the left anterior pararenal space suggestive of a hernial sac.
Inferior mesenteric vessels are running anteromedial to the hernial sac. The jejunal loops contained within the sac are enhanced normally and have no wall thickening. There is crowding and stretching of superior mesenteric vessels supplying jejunal bowel loops. There is mild free fluid in the abdomen.
The hernial sac displaces and compresses the pancreatic tail anteriorly. The mass effect upon the left upper ureter causes mild degree hydronephrosis. Descending colon is displaced anteriorly and abutting the anterior parietal peritoneum.
Proximal to the hernial sac, duodenum and stomach are mildly dilated. The majority of ileal loops are seen on the right side of the abdomen. Ileocecal junction is located in the normal place. No intestinal malrotation.
Status of post cholecystectomy.
First axial and coronal images - demonstrates duodenojejunal junction (fourth part of the duodenum) in yellow color and lateral location of the paraduodenal hernia.
The second and third axial images - demonstrates the anterior-medial location of the inferior mesenteric vein (blue color) and artery(red color) to the hernial sac.
Fourth axial image - demonstrates anterior displacement of descending colon (green arrow).
Case Discussion
Abdominal hernias are mainly divided into two categories namely external and internal hernias. Left paraduodenal hernia is the most prevalent type of internal hernia. This results from a failure of fusion of descending mesocolon with parietal peritoneum.
Surgical notes:
Herniation of jejunal bowel loops into the left paraduodenal fossa was identified. No evidence of bowel ischemia. Reduction of jejunal bowel loops and closure of hernial defect was done.
Unable to process the form. Check for errors and try again.