2010 Volume 30 Issue 1 Pages 61-64
A man in his twenties without any significant past medical history and no previous surgery presented at another hospital complaining of an upper abdominal pain lasting for 1 week. He was referred to our hospital from the emergency room for acute upper abdominal pain and frequent vomiting. At the initial examination, slight tenderness was found in the upper abdomen on palpation, without peritoneal signs. A plain abdominal X-ray revealed a small amount of gas in the small intestine. On a CT scan, a cyst-like structure was revealed protruding from the vicinity of the Treitz ligament towards the left anterior pararenal space, which contained a portion of distended intestine. Upper alimentary tract fluoroscopy demonstrated occlusion of the horizontal part of the duodenum. A diagnosis of incarcerated left paraduodenal hernia was made and the patient underwent an emergency operation. Paraduodenal hernias are rare internal hernias that develop near the Treitz ligament by invagination of the intestine into a peritoneal pouch. A cyst-like structure formed by the distended intestine loop on the CT scans is a typical radiological sign of paraduodenal hernia.
