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Special Feature
Apr 2012

Image of the Month—Diagnosis

Arch Surg. 2012;147(4):389-390. doi:10.1001/archsurg.2011.808b

In this patient, a right-sided paraduodenal hernia had been diagnosed by the use of computed tomographic scans and gastrointestinal contrast studies 1 year before an emergency operation. During the operation, the proximal jejunum, approximately 120 cm in length, was found to be strangulated through the right paraduodenal hernia (Figure 2). A nonviable bowel was resected, and the hernia defect was repaired. We found the cecum in the normal position without an obvious Ladd band. Intraoperative findings and above-described radiographic features were suggestive of underlying situations of malrotation. Ladd bands are well-known as the lateral attachments of the right colon in the typical case of a right paraduodenal hernia, because division of these bands is needed to allow for a reduction of the bowel by retraction to the left. The patient's postoperative course was uneventful.