Left paraduodenal hernia, a diagnostic challenge

Abstract

Left paraduodenal hernias, an abnormal protrusion of abdominal organs through a peritoneal defect into the fossa of Landzert, are a rare cause of small bowel obstruction. We present the case of a 21-year-old man with intermittent abdominal pain over several months. Diagnostic laparoscopy confirmed a left paraduodenal hernia. The hernia was reduced, and the fossa of Landzert was left widely open. This condition presents a diagnostic challenge, as symptoms are non-specific and imaging may appear unremarkable. Prompt diagnosis is essential to avoid complications such as strangulation and ischemia. Unlike conventional approaches, our surgical strategy involved enlarging and intentionally leaving the hernial defect open-justified by anatomical and pathophysiological reasoning. At 21-month follow-up, the patient remained symptom-free. This case highlights the importance of maintaining a high index of suspicion in similar clinical presentations and proposes an alternative surgical technique for managing this rare internal hernia.

Keywords: fossa of Landzert; internal hernia; paraduodenal hernia; small bowel obstruction.

Figure 1

An axial CT scan view revealing the presence of a small bowel loop (A) behind the splenic vein (B).

Figure 2

A coronal CT scan view demonstrating a cluster of small bowel loops (A) in the left abdomen.

Figure 3

A coronal CT scan view demonstrating once again the clustered small bowel loops (A) and the surrounding vasculature inferior mesenteric vein (B), superior mesenteric vein (C), portal vein (D) and splenic vein (E).

Figure 4

A laparoscopic view of the small bowel protruding through the hernia defect.

Figure 5

The fossa of Landzert is identified (A) alongside a fibrous band of tissue preventing the small bowel from moving freely through the fossa (B).

Figure 6

A laparoscopic view of the fibrous band being transected (A) and the fossa of Landzert (B).

Figure 7

The duodenum (A) and the fossa of Landzert, widely opened (B).