Diagnosis and Surgical Management of Landzert's Paraduodenal Hernia

Landzert's paraduodenal hernia is a rare congenital internal hernia that results from the failure of the left mesentery to fuse completely with the parietal peritoneum during embryological development. This creates a congenital defect, the fossa of Landzert, through which small bowel loops can herniate into the retroperitoneum, leading to intermittent or acute small bowel obstruction (SBO). We present the case of a 33-year-old man with a history of episodic postprandial abdominal pain who presented with acute-onset severe abdominal pain, nausea, and vomiting. Computed tomography (CT) revealed small bowel loops herniating through the fossa of Landzert, indicative of a left paraduodenal hernia, along with a closed-loop small bowel obstruction. The patient underwent laparoscopic repair with conversion to open reduction and primary suture repair using 2-0 Stratafix (Ethicon, Raritan, NJ) sutures of the left paraduodenal hernia without having to resect any bowel segments. No intraoperative complications occurred, and the patient remains free of gastrointestinal discomfort several months post-operation.