Presentation
Abdominal pain, nausea, and vomiting.
Patient Data
Abnormal rounded cluster of proximal small bowel left of midline with suspected hernia orifice lateral and posterior to the inferior mesenteric vein. Thickening and submucosal edema in the antrum and pylorus. Complex inflammatory right upper pole renal mass.
Case Discussion
Typical findings of a left paraduodenal internal hernia with a cluster of small bowel left of midline and hernia orifice posterior and lateral to the IMV, and important landmark for the fossa of Landzert.
There are two other important findings: inflammation in the antrum and pylorus related to peptic ulcer disease, and a right upper pole renal abscess.
Operative note (edited excerpt): "...the antrum and the pyloric channel were edematous...inspecting from the left at the ligament of Treitz, a large paraduodenal hernia was encountered. The 4th portion of the duodenum and proximal jejunum had slipped into a pocket posterior to the inferior mesenteric vessels. The small bowel was reduced from the hernia...at its completion, the hernia was well closed. The bowel was then repositioned within the abdomen."