Presentation
Intermittent abdominal pain (over weeks). Normal inflammatory markers.
Patient Data
An abnormal cluster of small bowel loops within the left anterior pararenal space. These bowel loops are contained within a hernia sac and the sac lies posterior to the inferior mesenteric vein.
No features of bowel obstruction or ischemia of the hernia contents however some mild mesenteric congestion.
Rotation of the bowel appears otherwise normal (duodenum crossing midline; cecum in expecting position in right iliac fossa). No other notable anatomical abnormality.
Case Discussion
This patient presented with intermittent abdominal pain with unremarkable inflammatory markers. A CT was performed due to abdominal tenderness. CT showed an internal hernia, which could be further characterized as a left paraduodenal hernia due to the location of the hernia sac (left anterior pararenal space) and its relationship to the inferior mesenteric vein (sac behind IMV).
The patient was taken to the theater and the operative record showed a left paraduodenal hernia without evidence of bowel compromise. It was reduced operatively.
Paraduodenal hernia is the most common type of internal hernia and is subdivided into left and right paraduodenal depending on the location of the mesenteric defect. Left paraduodenal herniae is the more common subtype and results from a defect at the fossa of Landzert within the left upper quadrant.
In this case, intermittent obstruction of the internal hernia was thought to be the most likely explanation for the patient's pain, and the hernia was reduced intra-operatively. The patient had an unremarkable recovery and no recurrence of symptoms was reported.
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