A Boy with Unexplained Recurrent Abdominal Pain

Abstract

Figure 2. Coronal enhanced computed tomography image showing small bowel loops located to the left of the Treitz ligament. Mesenteric vessels are displaced in the left quadrant. A 15-year-old boy presented with a 3-week history of postprandial self-limiting episodes of colicky abdominal pain with abdominal distension and sometimes vomiting. The physical examination was normal, but after a meal the patient experienced intense abdominal pain and sweating. A tender mass was palpated in the left upper quadrant. Abdominal radiograph and computed tomography scan revealed a cluster of dilated small bowel loops to the left of the Treitz ligament (Figures 1 and 2). A left paraduodenal hernia was suspected, and this was confirmed on laparoscopy. The patient was discharged 3 days after undergoing laparoscopic hernia repair. Left paraduodenal hernia occurs when small bowel loops prolapse into Landzert fossa through a congenital defect; this occurs in approximately 2% of the population. This may cause acute intestinal infarction owing to stretching of blood vessels. Classically, patients experience marked abdominal asymmetry, sweating, and tachycardia during the episodes of abdominal pain, but are usually asymptomatic between crises. Pediatricians should take care to not erroneously misdiagnose these cases as functional recurrent abdominal pain. n