case_images: PMC11707711_01
case_images: Axial CT of the abdomen and pelvis demonstrating a right upper quadrant hernia containing the small bowel (blue arrows)
case_images: cureus-0017-00000077031-i01.jpg
case_images: PMC11707711_01_cureus-0017-00000077031-i01.jpg
case_images: FIG1
case_images: However, CT of the abdomen and pelvis was concerning for internal hernia and abnormal orientation of the small intestine with pylorus, duodenum, and jejunum located in the right upper quadrant (Figures 1, 2).
case_images: Coronal CT of the abdomen and pelvis demonstrating inferior trajectory of the duodenum and a lack of duodenal sweep (red arrows) and herniation of the majority of the small bowel into right upper quadrant (blue arrows)
case_images: cureus-0017-00000077031-i02.jpg
case_images: PMC11707711_01_cureus-0017-00000077031-i02.jpg
case_images: FIG2
case_images: However, CT of the abdomen and pelvis was concerning for internal hernia and abnormal orientation of the small intestine with pylorus, duodenum, and jejunum located in the right upper quadrant (Figures 1, 2).
case_images: Internal herniation of the small bowel through the space created by the Ladd band
case_images: cureus-0017-00000077031-i03.jpg
case_images: PMC11707711_01_cureus-0017-00000077031-i03.jpg
case_images: FIG3
case_images: The cecum was identified, and small bowel was evaluated from distal to proximal until the site of the internal hernia was quickly identified (Figure 3).
case_images: A single Ladd band forming a potential space for herniation
case_images: cureus-0017-00000077031-i04.jpg
case_images: PMC11707711_01_cureus-0017-00000077031-i04.jpg
case_images: FIG4
case_images: Reduced small bowel appearing viable and well perfused
case_images: cureus-0017-00000077031-i05.jpg
case_images: PMC11707711_01_cureus-0017-00000077031-i05.jpg
case_images: FIG5
case_images: Narrow mesenteric base as classically described in congenital malrotation and variants
case_images: cureus-0017-00000077031-i06.jpg
case_images: PMC11707711_01_cureus-0017-00000077031-i06.jpg
case_images: FIG6
case_images: Blunt Tip without Nano-Coating Sealer/Divider, Medtronic, Minneapolis, MN) and the remaining incarcerated bowel was freed and inspected. Beginning at the cecum, the bowel was again evaluated from ileocecal valve to the ligament of Treitz revealing a narrow mesenteric base (Figure 6).
case_images: Post-operative anatomic arrangement with the small bowel residing in the patient's right hemi-abdomen and colon in the left
case_images: cureus-0017-00000077031-i07.jpg
case_images: PMC11707711_01_cureus-0017-00000077031-i07.jpg
case_images: FIG7
case_images: A laparoscopic right medial visceral rotation and appendectomy were completed allowing the small bowel to reside in the right hemi-abdomen and the colon in the left hemi-abdomen (Figure 7).