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Case Reports
. 2024 Dec 2;20(2):1165-1169.
doi: 10.1016/j.radcr.2024.11.005. eCollection 2025 Feb.

Left Para-duodenal hernia with distal bowel ischemia: An unusual presentation of the internal hernia: A case report and literature review

Manali Bhatta  1 , Shailendra Katwal  2 , Bigyan Paudel  3
Affiliations
Case Reports

Left Para-duodenal hernia with distal bowel ischemia: An unusual presentation of the internal hernia: A case report and literature review

Manali Bhatta et al. Radiol Case Rep. .

Abstract

Internal hernias, including Left para duodenal Hernias (LPDH), are rare and challenging to diagnose due to their nonspecific symptoms and complex anatomical presentation. This report presents a unique case of a 29-year-old female with preoperatively diagnosed uncomplicated LPDH, complicated by distal bowel ischemia-a manifestation not extensively documented in existing literature. Initial imaging revealed dilated jejunal loops indicative of LPDH, with subsequent contrast-enhanced computed tomography (CECT) showing ischemic changes in bowel segments distal to the hernia. Surgical exploration confirmed 120 cm of gangrenous bowel, necessitating resection and jejunostomy. This case highlights the diagnostic and therapeutic challenges of LPDH and highlights the crucial role of advanced imaging in identifying associated complications.

Keywords: Acute abdominal pain; Bowel ischemia; Internal hernia; Left Para duodenal hernia; Ligament of Treitz.

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Figures

Fig 1
Fig. 1
(A) Axial CECT image showing cluster of jejunal loops (white arrow) in left side of abdomen with fanned out mesentery. (B) Coronal CECT image showing left Para duodenal hernia in left upper quadrant with nonenhancing ischemic rest of the jejunal and ileal loops (black arrow) in mid and right half of abdomen.
Fig 2:
Fig. 2
Intra-operative image showing surgically confirmed closed loop obstruction.
See this image and copyright information in PMC

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