An Unusual Variant of a Left Paraduodenal Hernia Caused by Adhesion Between the Transverse Mesocolon and Mesojejunum: A Case Report

Abstract

A 75-year-old man with no history of abdominal surgery came to the emergency department complaining of pain in the epigastrium and vomiting, and a contrast-enhanced CT scan revealed a closed loop near the ligament of Treitz. Laparoscopic dissection of the adhesion was performed, and intraoperative exploration revealed that the adhesion between the transverse mesocolon and the mesojejunum near the ligament of Treitz had formed a hernia orifice, and an approximately 20-cm long segment of the proximal jejunum had intruded. The jejunum was extracted from the hernia orifice, and after dissecting all of the mesenteric adhesions, the hernia orifice was opened. The patient was discharged on postoperative day 10, and there have been no recurrences of the herniation as of 6 months postoperatively. In patients with a left paraduodenal hernia, the hernia orifice is found on the dorsal side of the inferior mesenteric vein (IMV) near the ligament of Treitz, whereas in patients with the variant of left paraduodenal hernia, the hernia orifice is found ventral to the IMV. Transverse mesocolon hernia is another type of hernia with a hernia orifice on the ventral side of the IMV, and because it is difficult to distinguish on preoperative images, the final diagnosis must be made intraoperatively. In the variant type, the hernia orifice can be treated by dissection alone, without sutures, and thus it is a good indication for laparoscopic surgery.