Laparoscopic treatment of incarcerated Landzert's hernia

Abstract

A 50-years old woman presented to the Emergency Department after 6 h of abdominal discomfort, pain, bowel distension, nausea and vomiting. She referred acute onset of oppressive pain in left upper quadrant and left flank with painful and tender abdomen. Bowel sounds were present. Rectal examination was unremarkable. Past medical history included hypertension and no previous abdominal surgery. Laboratory tests showed a slight increasing in white blood cell count (10.800/μL) and PCR (15 mg/dL). Computed tomography revealed a cluster of ileal or jejunal loops in the leftupper quadrant (lateral to the ligament of Treitz and posterior to the inferior mesenteric vein (IMV)) with dilated proximal small bowel loops (Fig. 1). The patient was placed in a slight anti-Trendelenburg position with a 10 right rotation. Three operative trocars were used. A laparoscopic exploration confirmed the diagnosis of a left paraduodenal hernia with about 130 cm of viable small bowel incarcerated. As well as adhesyolisis, gentle manoeuvres of traction and counter-traction with atraumatic graspers