Herbert M Hedberg, MD1, Baddr Shakhsheer, MD2, Stephen Haggerty, MD3. 1University of Chicago Medical Center, 2St. Louis Children’s Hospital, 3NorthShore University HealthSystem
Paraduodenal hernia accounts for 50% congenital internal hernias. These hernia defects are formed by anomalous rotation and fusion of the mesentery and peritoneum during embryological development. They are located near the root of the mesentery, and allow bowel to pass posterior to, and become contained by, the mesocolon. Paraduodenal hernias can be left or right sided, and are named for the side of the mesocolon that contains the hernia contents. Left sided hernias are three times more common than right, and pass through a defect named Fossa of Landzert. This defect is found in 2% of the population, and is anatomically positioned between the ligament of Treitz to the patient’s right, and posterior to the inferior mesenteric vein to the patient’s left. These hernias may be completely asymptomatic, discovered incidentally on imaging or surgical exploration, or can become incarcerated, causing abdominal pain and/or obstruction.
The case presented in this video is a 17 year old male with no significant medical history. His pain began suddenly and increased to 10/10 intensity over the course of 5 hours. CT revealed a large mass of bowel contained in the left upper quadrant, all visibly passing through the Fossa of Landzert. The hernia was reduced and the defect repaired using four 5mm laparoscopic ports. The repair was tension-free using intracorporeal suturing and permanent suture. The patient recovered without incident and went home on postoperative day two. He was seen in follow-up two weeks later and was recovering well with no complaints.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87853
Program Number: V125
Presentation Session: Friday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo