Right paraduodenal internal hernia

Case contributed by Michael P Hartung
Diagnosis certain


Hematuria work-up.

Patient Data

Age: 40 years
Gender: Female

Presentation hematuria work-up


Abnormal rounded cluster of nonobstructed small bowel right of midline. 

1 mth later with abdo pain


Volvulus of the proximal small bowel with clustering of the small bowel in the right abodomen. No obstruction or ischemia. 

Case Discussion

Right paraduodenal hernia is caused by an abnormal fossa that forms when the ascending mesocolon does not fuse with the posterior parietal peritoneum (fossa of Waldeyer), and are more common in the setting of intestinal malrotation. This fossa is located inferior to the third portion of the duodenum, and a very helpful landmark is the SMA and SMV running along the anteromedial free edge of the fossa. The vascular relationships, in this case, are best appreciated on the first study before the partial volvulus occurred. This patient had intermittent, low-grade abdominal pain over the year between the two studies, and thus it is helpful to recognize that internal hernias, obstruction, and volvulus can occur on a spectrum. 

Operative note edited findings: 

  • A large amount of small bowel within a hernia sac through the transverse mesocolon in a paraduodenal fashion through the ligament of Treitz.
  • Nonfixation of the cecum to the right lower quadrant.
  • All bowel was viable.

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