Hindawi Publishing Corporation Case Reports in Medicine Volume 2012, Article ID 529246, 2 pages doi:10.1155/2012/529246 Case Report Unusual Cause of Intestinal Obstruction: Left Paraduodenal Hernia Sami Akbulut Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey Correspondence should be addressed to Sami Akbulut, akbulutsami@gmail.com Received 13 November 2011; Accepted 2 January 2012 Academic Editor: Michail Varras Copyright © 2012 Sami Akbulut. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Internal intestinal hernia has been deﬁned as bulging of the intestines through a normal or an abnormal peritoneal or mesenteric opening. Paraduodenal hernias comprise 30%–53% of all internal intestinal herniations and account for 0.2%–0.9% of all bowel obstructions. In this paper, we aimed to present a male patient of 42 years of age who developed intestinal obstruction due to left paraduodenal hernias. Left paraduodenal hernia should be taken into consideration in the diﬀerential diagnosis in patients of relatively younger ages with no prior abdominal surgery who frequently have bowel obstruction episodes. 1. Introduction Internal intestinal hernia has been deﬁned as bulging of the intestines through a normal or an abnormal peritoneal or mesenteric opening. This clinical entity can occur for con- genital or acquired reasons and accounts for around 1%– 5.8% of all intestinal obstructions [1–3]. Although the intestinal herniations are divided into distinct subgroups based on the localizations, it is the paraduedonal hernias which are responsible in nearly half of the patients. Also known as Treitz’s hernia, the paraduedonal herniations even- tuate from abnormal rotation of intestine. Paraduedonal hernias comprise 30%–53% of all intestinal herniations and account for 0.2%–0.9% of all bowel obstructions [1–4]. In this study, we aimed to present a male patient of 42 years of age who developed intestinal obstruction due to left para- duedonal hernias. 2. Case Presentation A 42-year-old male patient was admitted to our emergency department with the complaints of nausea, vomiting, and abdominal pain that had lasted for 3 days and had shown progressive worsening. The patient especially expressed that the pain had intensiﬁed around the umbilical region and that he had been unable to pass stool or gas. The patient’s history revealed no systemic disease or prior operation. As for the vital signs of the patient, the blood pressure, the pulse rate, and the body temperature were measured to be 130/85 mmHg, 83 beats/min and 37.3◦C, respectively. Marked abdominal distension and rebound tenderness were detected in the physical examination performed, whereas no abdominal guarding was observed. In standing abdominal direct X-ray, widespread air-ﬂuid levels were observed. While no pathological ﬁnding was detected other than mild uremia in the blood chemistry, leukocyte counts was reported to be 16.450/mm3. We were not able to obtain ultrasonographic or contrast-enhanced abdominal CT evaluation because of the fact that the patient was admitted to our emergency depart- ment at 11.00 pm. Given the physical examination ﬁndings, plain X-ray imaging and the absence of any prior surgery in the case history, the patient was taken into surgery consid- ering that widespread peritonitis was likely to exist due to a possible congenital brid or a perforated appendicitis with delayed diagnosis. We observed, in the surgical exploration via midline incision, that all of the small intestinal segments except a distal ileal portion of 50–60 cm length was stuck in the sac of a left paraduedonal hernia. The inferior mesenteric vein constituted the anterior portion of the hernial sac from the oriﬁce (Figure 1). After reducing the intestinal segments in the hernial sac into the abdominal cavity, IMV was released alongside its length. Then followed sealing oﬀ