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Figure 5. A 48-year-old man presented with small bowel obstruction (SBO) due to left paraduodenal hernia. (a) Contrast-enhanced CT at the mid left abdomen demonstrates dilatation of clustered small-bowel loops (small white arrows) with converging mesenteric vessels (white arrow), causing right displacement of the superior mesenteric vessels (arrowhead). Mild left-sided hydronephrosis is also seen, as well as the small bowel faeces sign within the dilated loop (black arrow) (Reprinted with permission [12]). (b) CT section at a lower level shows the cluster of dilated small bowel loops (black arrows) causing asymmetrical bulging of the left abdominal wall. The engorged and crowded mesenteric vessels are seen converging toward the opening of the hernia sac (white arrows). Note the excreted contrast media within the right ureter with its absence on the left side related to the uro-mechanical disturbance (Reprinted with permission [13]). At surgery, a hernia sac, containing viable loops of almost the entire small intestine, was found in the left upper quadrant with the inferior mesenteric vein at its opening. Hernial repair was performed.
