Report of a case with a spontaneous mesenteric hematoma that ruptured into the small intestine

IntroductionA spontaneous mesenteric hematoma is a rare condition. Furthermore, it is extremely rare that the mesenteric hematoma caused gastrointestinal bleeding with an unknown etiology. We experienced a case with a spontaneous mesenteric hematoma that ruptured into the jejunum.Presentation of caseA 75-year-old man was referred to our hospital because of anal bleeding and anemia. Abdominal computed tomography (CT) showed a low density mass measuring 3.0 cm in diameter, including an enhanced spot. This finding suggested that a pseudo-aneurysm or mesenteric hematoma caused active bleeding into the jejunum. He underwent emergent laparotomy and partial resection of the jejunum and the mesentery including the tumor. A histological examination of the jejunum indicated no pathogenic findings causing active bleeding. And there were no findings suggesting the mesenteric aneurysm had developed.The patient had no history related to the development of a mesenteric hematoma, such as trauma, labor, surgery, or anticoagulant treatment. Therefore, we finally diagnosed that a spontaneous mesenteric hematoma had ruptured into the jejunum.Discussion and conclusionWe reported extremely rare condition that the mesenteric hematoma was developed and ruptured into the jejunum without definitive etiology.     

Abdominal Cystic Lymphangiomas in Pediatrics: Surgical Approach and Outcomes

Background : Abdominal Cystic lymphangiomas (ACL) are uncommon benign masses usually presented during infancy. Although extremely rare, they may cause complications; therefore, the recommended therapy is surgical excision. The purpose of this study is to report our experience with the diagnosis and surgical treatment of ACL in pediatric population.

Material and methods : From January 1994 to December 2009, 10 patients (6 females; 4 males) with diagnostic confirmation of ACL were retrospectively included in study. Children’s age ranged between 9 months and 8 years (mean age at diagnosis was 2.5 years). Clinical presentation, cyst location, imaging studies employed, surgical approach and pathologic features were analyzed.

Results : The most common symptom was abdominal pain but three cases were incidentally detected. One case had presented with acute abdomen after traumatic haemorrhage of the tumor. All patients were diagnosed with ultrasonography as first-line radiological study. MRI was used in last three cases. At surgery, concomitant bowel resection was necessary in 3 children. Location of the lesion (omentum, mesentery) did not influence the outcome but surgery was more difficult (operative time over three hours) in patients with lymphangioma affecting mesentery of the jejunum. Mean hospital stay after surgery was 6.7 days. Mean follow-up was 5.1 years. No recurrence of the cystic lymphangioma was noticed during follow-up. One case developed an intestinal occlusion due to bowel adhesions 1 year after surgery. Conclusions : ACL usually affect infants and young children and may present with spectrum of symptoms from an incidental finding to an acute life-threatening abdominal obstruction. Complete excision of the tumor is a safe and effective method in the management of ACL in pediatric population. Surgery is mandatory to avoid potential complications.     

Large mesenteric cyst mimicking an ovarian cyst in an 8-year-old: A case report

Introduction and importancePediatric mesenteric cysts, rare and usually benign intra-abdominal tumors, are a difficult preoperative diagnosis due to ambiguous clinical characteristics. The final diagnosis is typically established only during surgery or histological analysis.Case presentationAn 8-year-old female presented with five days of worsening abdominal pain, associated with nausea, vomiting, and fever, as well as vague tenderness in the right quadrants on examination. Computed tomography imaging showed a 10.5 × 8.7 × 7 cm abdominal mass, most suspicious for a cystic mass of ovarian origin. Upon diagnostic laparoscopy, a mesenteric cyst extending to the root of the mesentery was visualized and entirely resected after conversion to an exploratory laparotomy. Histopathological examination of both the cystic fluid and specimen suggest a benign mesenteric cyst.Clinical discussionAlthough mesenteric cysts are noticeably rare, it is important differential to consider in pediatric patients with non-specific symptoms like abdominal pain and distention, intestinal obstruction, or a palpable abdominal mass. Notably, these cysts can be managed successfully by complete surgical resection with an excellent outcome.ConclusionThis report recounts an interesting case of a large mesenteric cyst that mimicked an ovarian cyst in a pre-pubertal girl.     

Mesenteric neovascularization during spring-mediated intestinal lengthening

BackgroundShort gut syndrome, a condition characterized by inadequate absorption of nutrients owing to decreased bowel length, has minimal avenues for treatment. We have proposed spring-mediated distraction enterogenesis to lengthen bowel in porcine jejunum as a treatment for short gut. We aim to evaluate the extent of mesenteric neovascularization in segments of lengthened bowel via spring-mediated enterogenesis.MethodsFemale juvenile Yucatan pigs underwent laparotomy and insertion of gelatin-encapsulated compressed nitinol springs, held in place with plication sutures, into the jejunum. At surgery and sacrifice, macroscopic mesenteric blood vessels were counted between the plication sites. Histologic samples of the mesentery were obtained to evaluate microscopic vasculature.ResultsA statistically significant increase in macroscopic mesenteric blood vessels was seen after intestinal lengthening (before: 1.9 ± 0.7 vessels, after: 4.7 ± 1.2 vessels, p = 0.001). A statistical significance is also seen in the density of arterioles (control: 3.0 ± 3.0 vessels/mm, spring: 7.0 ± 9.0 vessels/mm, p = 0.01) and venules (control: 4.0 ± 3.0 vessels/mm, spring: 8.0 ± 8.0 vessels/mm, p = 0.003).ConclusionIntestinal segments lengthened by intraluminal springs demonstrated total greater number of macroscopic vessels and microscopic blood vessels per length of mesentery as compared to control. This suggests local changes within the mesentery to recruit blood supply to growing intestine.Level of evidenceN/AType of studyTreatment study.     

Intestinal Autotransplantation and In-Situ Resection of Recurrent Pancreatic Head Intraductal Tubulopapillary Neoplasm with Portal Cavernoma: A Case Report

BackgroundIntraductal tubulopapillary neoplasm (ITPN) is a new entity of a rare premalignant pancreatic neoplasia, and a radical curative resection is indicated. As with other tumors of the root of the mesentery, the proximity of the lesion to large splanchnic vessels, abdominal aorta, and inferior vena cava poses major risks of a massive hemorrhage and visceral ischemia using conventional surgical techniques. At times, these lesions are amenable for resection using novel techniques developed from organ transplantation. Multivisceral (allo-) transplantation should be considered when radical resection of a benign tumor is likely to compromise portal flow and possibly precipitate acute liver failure, but it may be associated with a long waitlist time and tumor progression. Autotransplantation offers a safe and curative resection of otherwise inoperable tumors in a bloodless field, an excellent exposure, and prevention of warm ischemic injury to the affected viscera, which are then autotransplanted.MethodsWe describe the en bloc resection of a large and recurrent ITPN of the pancreas, distal stomach, proximal duodenum, transverse colon, superior mesenteric vein, and portal cavernoma, followed by intestinal autotransplantation.ResultsA complete tumor resection was achieved with negative margins, adequate cold preservation of the reimplanted intestine, and without significant hemorrhage. The patient was discharged from the hospital 10 days later. The histopathologic examination revealed free-margin resection of ITPN with an associated invasive carcinoma. The patient received adjuvant chemotherapy with folinic acid, fluorouracil, and oxaliplatin and remains disease-free 20 months after surgery.ConclusionsAutotransplantation offers curative resection of otherwise unresectable lesions of the root of the mesentery.     

巨大十二指肠错构瘤致慢性贫血1例报告并文献复习

背景与目的 十二指肠错构瘤（BGH）是十二指肠良性肿瘤中比较少见的类型,因其临床表现不典型、缺乏特异性,导致术前诊断困难,往往易被漏诊或误诊,主要依靠术后病理确诊。巨大BGH的病例临床更是罕见。本文报告1例巨大BGH致慢性贫血的诊治过程,并结合既往文献对本病特点进行复习,以期为临床工作提供经验借鉴。方法 回顾性分析西安交通大学附属咸阳市中心医院肝胆外科收治的1例BGH患者的临床资料,结合前期文献资料进行复习总结。结果 患者,女性,49岁;因腹痛伴恶心、呕吐就诊西安交通大学附属咸阳市中心医院肝胆外科。患者既往有慢性贫血病史,月经规律,偶有柏油样便。入院上腹部B超检查见胰头内侧十二指肠部包块;上腹部CT检查见十二指肠降部及水平部肠壁弥漫性增厚,结构不清;上腹部MRI+MRCP检查见十二指肠降部及水平部与邻近空肠分界不清,肠管明显扩张扭曲,肠壁分界不清,肠壁水肿明显,可见同心圆样改变。胃镜检查考虑十二指肠占位,并镜下活检提示符合胃黏膜异位。上消化道造影提示十二指肠降段与水平段移行区近圆形充盈缺损,考虑良性占位可能性大。最终考虑十二指肠占位性病变并引起梗阻,剖腹探查术后行胰十二指肠切除术,切除标本送病理学检查,最终诊断为BGH,免疫组化MUC5AC（+）,术后恢复顺利出院。术后监测血常规,红细胞及血红蛋白逐渐恢复正常,随访12个月,患者一般状况良好,未诉不适,复查各项指标正常,继续随访。结论 巨大BGH致慢性贫血临床罕见,术前影像学检查往往很难提供有价值的信息,胃镜下活检有助于诊断,但阳性率低,最后确诊需依靠手术切除标本的组织病理学检查,病变较大时外科手术切除是治疗该病的有效手段。     

Primary adenocarcinoma of the fourth portion of the duodenum: “A case report and literature review”

INTRODUCTIONPrimary adenocarcinoma of the 4th portion of the duodenum is reported less frequently than those other portions of the duodenum. Therefore, few reports discuss the diagnosis and treatment of this malignancy.PRESENTATION OF CASEA 54-year-old woman was admitted to our hospital with a complaint of nausea and vomiting after a meal. Upper gastrointestinal examination and a duodenogram revealed a Type 2 tumor of the 4th portion of the duodenum, which was diagnosed as well-differentiated tubular adenocarcinoma by endoscopic biopsy. Partial resection of the duodenum and jejunum was performed on the basis of intraoperative evaluation of negative lymph node metastasis around the pancreas and proximal duodenum with no macroscopic invasion toward the pancreas and proximal duodenal margin. Her postoperative course was uneventful without any sign of recurrence 5 years later.DISCUSSIONPrimary adenocarcinoma in the 4th portion is relatively less common. It is not easy to diagnose this disease. Patients with primary duodenal adenocaricinoma, who are medically fit to undergo surgery, should be given the option of aggressive resection. Duodeno-cephalo-pancreatectomy remains the standard treatment for adenocarcinomas of the 1st and 2nd portion of the duodenum. Partial resection is the preferred surgical method for patients with adenocarcinoma of the 3rd and 4th portions of the duodenum.CONCLUSIONThis report describes a rare case of primary adenocarcinoma of the 4th portion of the duodenum, successfully treated by partial resection of the duodenum and jejunum. However, larger studies are required to clarify the indications for the preferred surgical method for this malignancy.     

Laparoscopic management for spontaneous jejunal perforation caused by nonspecific ulcer: A case report

IntroductionNonspecific small bowel ulcers are rare and there have been limited reports. We applied laparoscopic surgery successfully for the perforation caused by this disease of jejunum.Presentation of case: A 70-year-old man visited to our hospital with complaint of abdominal pain and fever. He was diagnosed abdominal peritonitis with findings of intraperitoneal gas and fluid. Emergency laparoscopic surgery was performed. A perforation 5 mm in diameter was recognized in jejunum opposite side of mesentery. Partial resection of jejunum with end-to-end anastomosis and peritoneal lavage were performed. Pathologically, an ulcer was recognized around the blowout perforation without specific inflammation. He was discharged uneventfully 12 days after surgery.ConclusionLaparoscopic surgery has diagnostic and therapeutic advantages because of its lower invasion with a good operation view, and in case of the small bowel, it is easy to shift extra-corporeal maneuver.     

A case of small bowel mesenteric pneumatosis: A multidisciplinary approach to clinical interpretation and intervention

IntroductionPneumatosis of the small bowel mesentery is rare and the preserve of case reports. This case report describes the importance of a multi-disciplinary team (MDT) approach to rare pathologies.Case reportA 78-year-old man presented to our unit with a two-day history of upper abdominal pain associated with nausea and intermittent vomiting. An urgent computed tomography (CT) scan was organised. The scan was grossly abnormal and difficult to interpret; it was reported as widespread intra-mural gas within the small bowel wall most likely secondary to extensive small bowel ischaemia. Although surgical intervention was very high risk (predicted P-possum mortality of over 60%) and there was a strong possibility that the patient would not recover from surgery, the disparity between clinical and radiological findings meant that a diagnostic laparoscopy was indicated. A diagnostic laparoscopy showed that the small bowel itself was normal but there was extensive gas within the mesentery, caused by a band adhesion which had eroded into the peritoneal layer of the small bowel mesentery.DiscussionPneumatosis of the small bowel mesentery is a pathological sign rather than a diagnosis and is characterised by gas within the mesenteric sleeves. It is likely associated with significant morbidity and therefore rarely observed as the majority with this sign would not be deemed suitable for surgical intervention.ConclusionThe case highlights an unusual pathology, rare imaging findings, the importance of a multi-disciplinary approach and the value of clear communication and informed consent when considering major intervention or surgery.     

Complete Resection of a Complicated Huge Mesenteric Lymphangioma Guided by Mesenteric Computed Tomography Angiography With Three-Dimensional Reconstruction: Report of a Case

We herein describe the case of an adult with a complicated huge lymphangioma of the small bowel mesentery. Computed tomography (CT) confirmed a 45 × 30 × 14 cm multiple and separate, mixed and solid cystic tumor without enhancement by contrast medium in the abdominal cavity. Mesenteric CT angiography with three-dimensional (3D) reconstruction showed that the tumor did not involve the first jejunal artery, although the tumor did involve the subsequent jejunal and ileal arteries and the corresponding segment of the small bowel. Under anatomic guidance based on mesenteric CT angiography with 3D reconstruction, we were able to successfully excise the tumor. Mesenteric lymphangioma should be excised even when the tumor is asymptomatic. Mesenteric CT angiography with 3D reconstruction is useful for the surgical treatment of huge mesenteric tumors.Key words: Mesenteric lymphangioma, CT angiographyLymphangioma occurs mainly in children, with 80% to 90% of cases being diagnosed in the first year of life, and more than 95% of lymphangiomas are found in the head, neck, and axillary region.^1,2 On the other hand, intra-abdominal mesenteric lymphangioma is an uncommon tumor, but of the intraperitoneal sites, the small bowel mesentery is the most common site (70% of cases).² On occasion, mesenteric lymphangioma has been reported to grow to an enormous size and to behave aggressively in an invasive manner.^2–8We herein describe the case of an adult with a huge lymphangioma of the small bowel mesentery—the largest one reported thus far—that was complicated with intestinal obstruction and infection.^2–8 This report emphasizes the fact that the primary treatment for lymphangioma is radical surgical excision, even when the tumor is asymptomatic. In addition, mesenteric computed tomography (CT) angiography with three-dimensional (3D) reconstruction was useful in investigating the spread of the involved small bowel mesentery and in planning the surgical procedure in our case. We therefore discuss the role of mesenteric CT angiography with 3D reconstruction when planning and performing surgery for a huge abdominal tumor.     

Granular cell tumor presenting with perforation of fourth part of the duodenum: A case report

IntroductionGranular cell tumors (GCT) are relatively rare neoplasms most commonly occurring in skin or soft tissues. GCT are thought to be of Schwann cell origin and strongly positive for s100 protein. GCT of the intestinal tract are usually asymptomatic and found incidentally in the esophagus on endoscopy.Case presentationHere, we present a case of GCT jejunum and the fourth part of the duodenum. The patient is a 41-year-old female who presented with abdominal pain and was subsequently found to have pneumoperitoneum with a perforation of the fourth part of the duodenum. Intraoperatively, there were multiple enlarged and hard mesenteric lymph nodes, which were found to be due to GCT involving the fourth duodenum and proximal jejunum.Clinical discussionThe occurrence of GCT in the gastrointestinal (GI) tract are even less common accounting for 5–9% of all GCT with very few cases reported in the duodenum. GCT of the GI tract are often asymptomatic, consequently leading to misdiagnosed delays in treatment.ConclusionIn the setting of GCT in the fourth part of the duodenum with evidence of locally advanced disease, local resection is the preferred treatment.     

Mesenteric desmoid tumour presenting with recurrent abdominal abscess and duodenal fistula: A case report and review of literature

IntroductionDesmoid tumors are locally destructive but histologically benign. Their management involves close observation and surgical, medical, or hormonal treatment.Presentation of the caseA 36-year-old male was admitted for abdominal pain and fever. A CT scan showed fluid collections and air within a mesenteric mass. Diagnostic laparotomy was performed with drainage of the abscess and biopsy of the mass. The pathology suggested a desmoid tumor. His fever and abdominal pain persisted. An endoscopy was performed, which demonstrated a fistula track in the third part of the duodenum. After a multidisciplinary discussion, consensus was to pursue surgical intervention. The patient underwent an en bloc resection of the tumor including a portion of the wall of the third part of the duodenum. The final pathology confirmed a desmoid tumor with a fistula track to the duodenum. The patient had a re-laparotomy on POD2 for intra-abdominal bleeding but was discharged without further events on POD7. He had no evidence of recurrence on follow-up at 11 months.DiscussionDesmoid tumors are rarely complicated by abscess formation or fistulization. The management of intra-abdominal desmoids in this setting is challenging, as patients are often symptomatic and unresponsive to medical management. Percutaneous drainage and antibiotics are often initiated as first-line treatment, followed by surgery or medical therapy after evaluation of resectability and tumor stage.ConclusionRare complications can arise with intra-abdominal desmoid tumors. Principles of infection control should be applied in combination with optimization of oncologic outcome. A multidisciplinary approach helps to achieve both these objectives.     

Giant cystic lymphangioma of right mesocolon: A case report

IntroductionCystic lymphangiomas are rare benign tumors of the lymph vessels and are usually found in children. However, abdominal cystic lymphangioma in mesocolon is extremely rare in adult patients.Presentation of caseWe reported a 15-year-old female with giant cystic lymphangioma of the right mesocolon. On examination, only abdominal pain was confirmed. Abdominal computed tomography (CT) showed a large multiseptated cystic mass. The patient underwent a total right mesocolic excision with the lesion. The patient recovered well on postoperative follow-up and was discharged on the fifth day. No evidence of recurrence had also been found in three months follow-up period.DiscussionThe diagnosis of intra-abdominal cystic lymphoma is often dismissed because the clinical symptoms are nonspecific. It is easy confusion because the ultrasound and CT scan images are relatively similar to the mesenteric and omental cysts. Sclerosing therapies may cause long-term consequences such as local recurrences with a very high proportion. Complete resection, including resection of the involved organs, is necessary. With tumors surrounding the colon, surgeons should consider performing removal block colon-lesion.ConclusionComplete tumor removal is the optimal choice for the management of intra-abdominal cystic lymphangioma. However, incomplete resection may lead to local recurrence.     

Mesenteric cystic lymphangioma: A case report

Introduction and importanceMesenteric cystic lymphangiomas are rare benign lesions of the abdominal cavity characterized by lymphatic vessels malformation with an unknown etiology. Despite the silent clinical course of mesenteric cystic lymphangiomas, they are considered as clinically tricky lesions with an immense spectrum of presentations.Case presentationWe present a case of abdominal mesenteric cystic lymphangioma in a 1-year 9-month-old female patient, who complained of fever and abdominal pain for 10 days duration. Laboratory investigations, abdominal X-ray, ultrasonography, computed tomography and histopathological examination were all used to establish the diagnosis.Clinical discussionA trial of true-cut biopsies performed by an interventional radiologist was not informative, so a multidisciplinary team decision was made to excise the mass. Intraoperative findings include multiloculated fused cystic lesion (8.0 × 5.0 × 4.0 cm) on the descending mesocolon. Histopathological examination revealed the diagnosis of a mesenteric cystic lymphangioma. The postoperative period was not complicated.ConclusionMesenteric cystic lymphangiomas are mostly asymptomatic in nature, yet predisposed to life threating events. Surgical excision is the modality of treatment characterized by low recurrence rate and a non-complicated postoperative period.     

Multiple gastrointestinal stromal tumors in neurofibromatosis type 1: Report of a case

This report presents a case of multiple gastrointestinal stromal tumors (GIST) with neurofibromatosis type 1 (NF1). A 68-year-old woman was admitted to the hospital because of a tumor close to the head of the pancreas. Imaging studies revealed submucosal tumors of the duodenum. The retroperitoneal tumor was diagnosed before surgery. Besides the main tumor in the duodenum, multiple small submucosal tumors were found in the duodenum and upper part of the jejunum during the operation. All of these tumors were resected. The histological diagnosis of all these tumors was GISTs. These tumors were immunohistochemically positive for KIT, but they demonstrated no mutation in c-kit exons 9, 11, 13, and 17, and platelet-derived growth factor receptor α exons 12 and 18. No recurrence occurred for a year after surgery.     

Strangulated Umbilical Hernia Including a Mesenteric Cyst: a Rare Cause of Acute Abdomen

Mesenteric cysts are rare intra-abdominal lesions. They are usually diagnosed as an incidental laparotomy finding in adults but in childhood, they may present with acute abdomen.

In this report, a 72-year old female was referred to our hospital, suffering from acute abdominal pain, several episodes of nausea and vomiting. Clinical abdominal examination revealed an irreducible recurrent umbilical hernia. The patient had both muscular defense and abdominal tenderness. Plain abdominal radiography showed multiple air-fluid levels. With these findings, a diagnosis of acute abdominal pathology was accepted and an urgent laparotomy was performed. A 5-cm-diameter mesenteric cyst was excised from the mesentery of the proximal jejunum and a prosthetic mesh was placed for incisional hernia. This is the first report of a strangulated umbilical hernia complicated with a mesenteric cyst.     

Coexistence of duodenum derived aggressive fibromatosis and paraduodenal hydatid cyst: A case report and review of literature

Intra-abdominal aggressive fibromatosis is a locally aggressive tumor mostly originating from the mesentery or retroperitoneal space, infiltrating adjacent tissues, and very rarely metastasizing to distant organs. There are only two case reports in the English language literature where intra-abdominal aggressive fibromatosis originated from the intestinal wall. In this study, we aimed to report a case of aggressive fibromatosis originating from the muscularis propria layer of the duodenum and invading pancreas. Another interesting aspect of this case is that a primary paraduodenal hydatid cyst was incidentally detected in the surgical specimen. A 46-year-old female patient presented to our clinic with postprandial nausea and vomiting. A contrast-enhanced abdominal computerized tomography revealed a mass lesion with a size of 100 mm × 80 mm which originated from the distal pancreas and compressed the gastric pilor externally. Upon exploration the distal part of duodenum, proximaljejunum, and pancreatic mass were noted to form a conglomerated structure. Therefore, the fourth part of the duodenum, a 25 cm part of the proximal jejunum, distal pancreas, and the spleen were excised enbloc. The pathology report of the specimen indicated fibromatosis with a diameter of 55 mm that originated from the muscularis propria of the duodenum and extended into the pancreatic parenchyma. There was also an incidentally detected 10 mm paraduodenal hydatid cyst. No tumor recurrence was detected at a follow-up period of 24 mo. In conclusion, the most ideal treatment of desmoid-type fibromatosis is surgical resection of the mass lesion with clean surgical borders. Although rare, this tumor may originate from the intestinal wall. Histopathological verification is of great significance for a proper diagnosis.     

Lymphangioma of small bowel in adults: A rare cause of abdominal symptoms

BackgroundLymphangioma is unusual malformation of the lymphatic system and rarely occurred in adults below diaphragm. Lymphangioma in small intestine sometimes caused unspecific symptoms and even bleeding, however, this area was most difficult for endoscopic examination and worth investigation.MethodsFrom 1999 to 2019, we retrospectively collected eighteen adult patients with the pathological diagnosis of lymphangioma from duodenum to terminal ileum. The clinical symptoms, origin site, predisposing factor, pre-operative image surveillance, surgical intervention, histopathological findings, follow-up period, and outcome were reviewed and analyzed.ResultsThe mean age of diagnosis was 50.11 years old with female predominance. The most common symptoms were abdominal pain (77.78%), palpable mass (27.78%) and intestinal bleeding (16.67%). With the different gross and microscopic findings, the adult intestinal lymphangioma could be classified as “simple”, “polyposis”, and “cystic cavernous”.ConclusionIntestinal lymphangioma in adults is a rare cause of abdominal discomfort but should be listed in differential diagnosis during daily practice. The morphology and classification may be different from pediatric group, and more large-scale studies are need for thorough investigation.     

An unusual variant of a left paraduodenal hernia diagnosed and treated by laparoscopic surgery: Report of a case

An 80-year-old woman who had undergone both a cholecystectomy and an appendectomy presented with intermittent abdominal pain. Computed tomography (CT) revealed an encapsulated circumscribed cluster of jejunal loops in the left upper quadrant. The hernia orifice was adjacent to the left side of the superior mesenteric artery and vein. An upper gastrointestinal series also revealed a cluster of jejunal loops, suggesting the possibility of an internal hernia. Laparoscopic surgery was performed. The hernia orifice was found to be caused by abnormal adhesion between the transverse mesocolon and the jejunum mesentery. An adhesiotomy reduced the jejunum entrapped in the hernia. The hernia space was a large mesocolic fossa composed of transverse mesocolon and mesentery, continuing to the splenic flexure. The hernia was classified as a variant of paraduodenal hernia.