Left paraduodenal hernia, a diagnostic challenge

Left paraduodenal hernias, an abnormal protrusion of abdominal organs through a peritoneal defect into the fossa of Landzert, are a rare cause of small bowel obstruction. We present the case of a 21-year-old man with intermittent abdominal pain over several months. Diagnostic laparoscopy confirmed a left paraduodenal hernia. The hernia was reduced, and the fossa of Landzert was left widely open. This condition presents a diagnostic challenge, as symptoms are non-specific and imaging may appear unremarkable. Prompt diagnosis is essential to avoid complications such as strangulation and ischemia. Unlike conventional approaches, our surgical strategy involved enlarging and intentionally leaving the hernial defect open-justified by anatomical and pathophysiological reasoning. At 21-month follow-up, the patient remained symptom-free. This case highlights the importance of maintaining a high index of suspicion in similar clinical presentations and proposes an alternative surgical technique for managing this rare internal hernia.