2026 Volume 62 Issue 2 Pages 188-195
The patient, a 12-year-old boy with no history of abdominal surgeries, first presented with upper abdominal pain at 9 years of age. Over the subsequent 3 years, he was evaluated multiple times for similar complaints. Physical examination revealed an upper abdominal distention. Plain abdominal radiography revealed a marked gastric bubble dilation. An upper gastrointestinal contrast study demonstrated impaired passage in the duodenum immediately anterior to the vertebral body, raising suspicion of superior mesenteric artery syndrome. Although the contrast agent eventually flowed into the small intestine after positional adjustment, stasis was observed in the upper-left quadrant. Contrast-enhanced abdominal computed tomography (CT) revealed gradual rotation of the mesenteric vessels; however, there was no evidence of small intestine dilatation or mechanical obstruction. As the findings of these investigations were inconclusive, the patient underwent diagnostic laparoscopy at 12 years of age. A fibrous band was present between the ascending portion of the duodenum and the descending colon, prompting medial traction of the descending colon. The normal anatomical duodenal recess served as the hernial orifice, leading to a diagnosis of atypical left paraduodenal hernia. Diagnostic laparoscopy is a minimally invasive procedure and allows the comprehensive evaluation of the abdominal cavity. As such, this procedure should be considered for patients with persistent abdominal symptoms whose underlying cause cannot be identified using noninvasive methods.
