Tamiladu & Pondicherry Chapter of Indian Radiological and Imaging Association
Promoting the study and practice of Diagnostic Radiological Imaging Modalities in the states of Tamilnadu and Pondicherry
Answer to Quiz No. 67 dated 19 June 2016
Left paraduodenal hernia
Findings
Sac-like mass of jejunal loops noted clustered inferior to and between the pancreas and stomach, displacing the descending colon laterally, with inferior mesenteric vein located at the anterior margin of the clusterered loops. Involved loops are collapsed, with no evidence of bowel obstruction. No free fluid noted.
Discussion
Paraduodenal hernias were the most common type of internal hernia. It is an aperture subtype occuring congenitaly. Left paraduodenal hernia occur when bowel prolapses through Landzert's fossa. Landzert's fossa is seen in approximately 2% of the population. Small-bowel loops prolapse posteroinferiorly through the fossa to the left of the fourth part of the duodenum into the left portion of the transverse mesocolon and descending mesocolon. On CT these hernias will present as an encapsulated circumscribed mass of a few loops of small bowel (usually jejunal) is seen either at the duodenojejunal junction between the stomach and pancreas to the left of the ligament of Treitz; behind the pancreatic tail itself, displacing the inferior mesenteric vein to the left; or between the transverse colon and the left adrenal gland.
References
Takeyama N, Gokan T, Ohgiya Y, Satoh S, Hashizume T, Hataya K, et al. CT of Internal Hernias. RadioGraphics. 2005 Jul 1;25(4):997–1015. Martin LC, Merkle EM, Thompson WM. Review of Internal Hernias: Radiographic and Clinical Findings. American Journal of Roentgenology. 2006 Mar 1;186(3):703–17.
Findings
Sac-like mass of jejunal loops noted clustered inferior to and between the pancreas and stomach, displacing the descending colon laterally, with inferior mesenteric vein located at the anterior margin of the clusterered loops. Involved loops are collapsed, with no evidence of bowel obstruction. No free fluid noted.
Discussion
Paraduodenal hernias were the most common type of internal hernia. It is an aperture subtype occuring congenitaly. Left paraduodenal hernia occur when bowel prolapses through Landzert's fossa. Landzert's fossa is seen in approximately 2% of the population. Small-bowel loops prolapse posteroinferiorly through the fossa to the left of the fourth part of the duodenum into the left portion of the transverse mesocolon and descending mesocolon. On CT these hernias will present as an encapsulated circumscribed mass of a few loops of small bowel (usually jejunal) is seen either at the duodenojejunal junction between the stomach and pancreas to the left of the ligament of Treitz; behind the pancreatic tail itself, displacing the inferior mesenteric vein to the left; or between the transverse colon and the left adrenal gland.
References
Takeyama N, Gokan T, Ohgiya Y, Satoh S, Hashizume T, Hataya K, et al. CT of Internal Hernias. RadioGraphics. 2005 Jul 1;25(4):997–1015. Martin LC, Merkle EM, Thompson WM. Review of Internal Hernias: Radiographic and Clinical Findings. American Journal of Roentgenology. 2006 Mar 1;186(3):703–17.
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