At laparotomy for small bowel obstruction, dilated jejunal loops are found packed inside a narrow peritoneal pocket lying immediately to the left of the fourth part of the duodenum. This left paraduodenal hernia passes through the fossa of Landzert. Which vessel runs in the free peritoneal fold forming the neck of this hernial sac?

• A Left gastric artery
• B Inferior pancreaticoduodenal artery
• C Middle colic artery
• D Inferior mesenteric vein ✓

Explanation

The paraduodenal fossa of Landzert lies to the left of the duodenojejunal junction beneath a peritoneal fold raised by the inferior mesenteric vein and the ascending left colic artery. During development the small intestine herniates into this unfused recess, producing the commonest congenital internal hernia. The neck therefore contains the inferior mesenteric vein, which the surgeon must avoid when enlarging the ring. The other listed vessels lie elsewhere in the foregut and midgut mesenteries.

Reference: Last's Anatomy: Regional and Applied, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.