PMC4818316_01
Abdomen CT scan shows a "cluster" of jejunal loops in the left upper abdomen (black arrows).
gr1.jpg
PMC4818316_01_gr1.jpg
fig0005
No dilatation of the jejunum was observed (Fig. 1, Fig. 2).
Laparoscopic view of the hernia orifice. This intraoperative image shows the Landzert's fossa (empty white arrow), bounded by the first jejunal loop to the left (empty black arrow), the neck of the sac up and to the right (solid black arrow) and the mesentery below.
gr3.jpg
PMC4818316_01_gr3.jpg
fig0015
During laparoscopy, the small bowel was found completely herniated under the inferior mesenteric vessels (Fig. 3).
Laparoscopic view of 3-0 V-Loc  intracorporeal continuous suture. This intraoperative image shows the closing of hernia orifice using continuous suture of the neck of the sac (solid black arrows) and the first jejunal loops (empty black arrow).
gr4.jpg
PMC4818316_01_gr4.jpg
fig0020
Then, the hernia space (Landzert's fossa) was simply closed with a running barbed 3-0 V-Loc  suture between the neck of the sac and the first jejunal loops (Fig. 4).