2 Figure 1: Left paraduedonal hernia sac. The red arrow points to the hernia sac, while the yellow arrow indicates inferior mesenteric vein, constituting a wall of the hernial sac. the oriﬁce of the sac with sutures. The patient was discharged from the hospital on the 5th day after surgery without any complication. 3. Discussion Intestinal hernias are entitled according to the oriﬁces they pass through or to the position of the herniating organ. Based on the former deﬁnition, the most commonly seen hernia types are as follows: paraduedonal, transmesenteric, perice- cal, intersigmoid, supravesical, foramen Winslow, retroanas- tomotic, and omental hernias. Paraduedonal hernia was ﬁrst deﬁned by Treitz in 1857. Paraduedonal hernia is the most common form among intestinal hernias, accounting for 30%–53% of all cases. Paraduedonal hernias result from ab- normal rotation of the midgut during embryonic develop- ment and can be divided into two subtypes, left and right paraduedonal hernias, according to their distinct pathogen- esis and the resultant anatomical derangement. 75% of them are located on the left side in the Landzert’s paraduedonal fossa [3, 5]. Around 50% of the patients with paraduedonal hernias had episodes of intestinal obstruction in certain periods of their lives. The symptoms seen in these cases can range from temporary colicky pain in abdomen to the signs of intestinal obstruction. The remaining 50% of the cases follow an asymptomatic clinical course and are diagnosed incidentally [1]. Imaging methods play a pivotal role in the diagnosis of intestinal herniations. Plain X-rays can yield information regarding the intestinal segment from which the herniation stems and extension of the intestinal obstruction, while abdominal CT shows dislocated, distended, expanded, and gathered small intestinal segments [1, 5]. Moreover, CT can also indicate the dislocations of mesenteric vascular structures. Recently, diagnostic laparoscopy has provided the abilities of both veriﬁcation of the diagnosis and simultane- ous surgical intervention in cases that could not be diagnosed Case Reports in Medicine by radiological methods. The basic principles applied in the treatments of any kinds of herniations also hold true in the treatment of paraduedonal herniations. These are the repair of the defect and the resection of the hernial sac at times when reduction of incarcerated intestinal segments is neces- sary. In conclusion, left paraduedonal hernia is one of the rare causes of small bowel obstruction. It should be taken into consideration in the diﬀerential diagnosis in patients of re- latively younger ages with no prior abdominal surgery who frequently have bowel obstruction episodes. References [1] M. S¸ en, A. Inan, C. Dener, and M. Bozer, “Paraduodenal inter- nal hernias: Clinical analysis of two cases,” Ulusal Travma ve Acil Cerrahi Dergisi, vol. 13, no. 3, pp. 232–236, 2007. [2] C. T. Lin, K. F. Hsu, Z. J. Hong et al., “A paraduodenal hernia (Treitz’s hernia) causing acute bowel obstruction,” Revista espan˜ola de Enfermedades Digestivas, vol. 102, no. 3, pp. 220– 221, 2010. [3] L. C. Martin, E. M. Merkle, and W. M. Thompson, “Review of internal hernias: radiographic and clinical ﬁndings,” American Journal of Roentgenology, vol. 186, no. 3, pp. 703–717, 2006. [4] G. Virich and W. Davies, “A massive left paraduodenal fossa hernia as an unusual cause of small bowel obstruction,” Annals of the Royal College of Surgeons of England, vol. 92, no. 4, pp. 7–9, 2010. [5] V. Brehm, R. Smithuis, and P. G. Doornebosch, “A left para- duodenal hernia causing acute bowel obstruction: a case re- port,” Acta Chirurgica Belgica, vol. 106, no. 4, pp. 436–437, 2006.