腹內腸疝脫是造成腸阻塞的少見原因之一。大部分腹內腸疝脫的病例均是左側十二指腸腹內腸疝脫，它是因為腸子經由十二指腸第四部份的左側疝脫入Landzert小窩內所造成的；病人並不會有特殊的臨床症狀而且術前的影像學診斷相當困難，然而若因此延遲了手術治療，會明顯增加死亡的機會。在影像上要辨識大量疝脫的腸子呈現聚集在一起、形成團塊的樣子很不容易，造成診斷大量左側十二指腸腹內腸疝脫更是困難。在這裡我們報告一個未能術前診斷的大量左側十二指腸腹內腸疝脫的案例，藉著探討病人的影像學檢查，與術中的發現比對，提出一些線索來增加它的診斷率。
Internal hernia is a rare cause of intestinal obstruction and most cases of internal hernia are left paraduodenal hernia. It typically involves the fossa of Landzert just lateral to the fourth portion of the duodenum. Patients with left paraduodenal hernia do not have specific clinical manifestations and preoperative radiological diagnosis is difficult. Mortality increases significantly with delay in surgical treatment. It is difficult to diagnose large left paraduodenal hernia because the grouped bowel loops not easy to look like an agglomerated mass. We now present a case of large left paraduodenal hernia which was not diagnosed in reoperative images. By retrospectively reviewing the images, we correlate the operative and the imaging findings and propose some clues that may increase the accuracy of diagnosis.
