title: Paraduodenal herniation: An internal herniation in a virgin abdomen.
abstract: BACKGROUND
  A paraduodenal hernia is an uncommon hernia that results from an abnormal rotation of the midgut. Commonly, these hernias are congenital in nature, and are reported to cause 1.5-5.8% of intestinal obstructions. These hernias occur when a part of the jejunum herniates through the posterior portion of the ligament of Treitz. Diagnosing these hernias preoperatively has been shown to be difficult, despite the studies that are available. Early diagnosis is imperative to the patient in order to avoid strangulation of the bowel, which is associated with a high mortality.
  
  
  METHODS
  In this case, we present a case of a left-sided paraduodenal hernia in a virgin abdomen in a 38-year-old African American male with a herniation of a loop of jejunum through a defect of the posterior portion of the ligament of Treitz. The patient also had a volvulized segment of the proximal jejunum, and part of this bowel was found to be ischemic.
  
  
  CONCLUSIONS
  Acute intestinal obstruction caused by a left paraduodenal hernia is a rare cause of intestinal obstruction. A literary search of PubMed between 1980 and 2012 indicated only 44 cases of intestinal obstruction secondary to a left paraduodenal hernia.
  
  
  CONCLUSIONS
  The patient underwent exploratory laparotomy, and the herniated bowel was found to be ischemic. The hernia was reduced, and the ischemic bowel resected. The defect was closed, and the patient had a non-complicated recovery.
authors.affiliation: Detroit Medical Center, Sinai Grace Hospital, Department of Surgery, 6071 W. Outer Dr., Detroit, MI 48235, United States. Electronic address: dkabbani@gmail.com.
authors.forename: Dana
authors.initials: D
authors.lastname: Kabbani
authors.affiliation: Detroit Medical Center, Sinai Grace Hospital, Department of Surgery, 6071 W. Outer Dr., Detroit, MI 48235, United States.
authors.forename: Ayman
authors.initials: A
authors.lastname: Salem
authors.affiliation: Detroit Medical Center, Sinai Grace Hospital, Department of Surgery, 6071 W. Outer Dr., Detroit, MI 48235, United States.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Holloway
keywords: Ligament of Treitz; Paraduodenal hernia