Incarcerated Paraduodenal Hernia in the Intermesocolic Fossa —A Case Report—

Abstract

A 75-year-old woman was brought to the emergency department with abdominal pain. Contrast-enhanced computed tomography (CT) showed stenosis of the jejunum near the ligament of Treitz, formation of a closed loop, and a sac-like appearance. The herniated small bowel was located to the left of the middle colic artery. Both the superior and inferior mesenteric arteries were in their normal positions, without evidence of malrotation, and no typical CT findings of a left or right paraduodenal hernia were observed. Although the hernia orifice could not be identified preoperatively, an incarcerated paraduodenal hernia was suspected, and emergency surgery was performed. Approximately 30 cm of jejunum, beginning 10 cm distal to the ligament of Treitz, were incarcerated and necrotic within the intermesocolic fossa. The necrotic bowel was resected, the hernia orifice was closed by suturing, and the jejunum was fixed to the transverse mesocolon. An extremely rare case of an incarcerated paraduodenal hernia arising in the intermesocolic fossa was described.