Laparoscopic Repair of a Left Paraduodenal Hernia at the Ligament of Treitz-A Case Report

Luanne Force, MD, Jihan Hegazy, MD, Jay J Strain, MD, Amit Joshi, MD

Department of Surgery, Albert Einstein Healthcare Network

We report the case of a 25-year old female who was referred to our clinic with two prior episodes of acute onset of nausea, vomiting, and abdominal pain. She underwent computed tomography (CT) of the abdomen and pelvis. This showed that the majority of her small intestine was clustered in the left flank. These intestinal loops appeared to be herniated through a defect in the mesocolon. The patient had no prior surgical history.

Methods and Procedures
The patient was taken to the operating room for diagnostic laparoscopy. Three right-sided ports were placed and the entire mesocolon from the hepatic flexure to the pelvis was explored. None of her small intestine was actively herniated. However, we identified a patulous ligament of Treitz that had incomplete anatomic adhesions, that was a hernia site through the transverse mesocolon. The ligament of Treitz was suture closed with two interrupted 2-0 silk sutures placed laparascopically. The patient was discharged home the same day.

The operating room time was 79 minutes. EBL was minimal. The patient tolerated the procedure, well, and at 5 months follow-up, was doing well without any recurrence of abdominal pain.

We recommend exploration of all patients with internal hernias, particularly when they have no antecedent surgical history. Even when no herniated intestine is found, we advocate for thorough exploration of the typical hernia sites within the small intestine and colonic mesentery. Closure of internal hernias can be laparoscopically performed on an outpatient basis.

Session: Poster Presentation

Program Number: P285

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