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In the case of this patient, we traced the small bowel back to a transition point where herniation through a defect in the transverse colonic mesentery was found. This defect was identified to be in the left paraduodenal space. Therefore, this defect was opened laterally, taking care to protect the vessels at the hernia sac margin. The herniated bowel (approximately half of the small bowel) was reduced and inspected carefully for viability. The hernia defect was repaired with a running vicryl stitch, and once again avoiding the vessels at the mouth of the defect. The patient recovered well and was having normal bowel movements by postoperative day 5. At the 3-week postoperative follow-up examination, all symptoms had resolved and the patient had no complaints.
Image of the Month—Diagnosis. Arch Surg. 2006;141(7):711–712. doi:https://doi.org/10.1001/archsurg.141.7.712
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