A diagnostic dilemma: hernia through the fossa of Landzert masquerading as peptic ulcer disease.

Paraduodenal hernia is the most common type of internal hernia, accounting for 30-50% of cases. It often results from congenital defects caused by errors during intestinal rotation and fixation during embryonic development. These hernias can present as nonspecific abdominal pain or acute intestinal obstruction, making diagnosis challenging. In this case report, a young man, in his early 30s, presented with acute upper abdominal pain, obstipation and distension. Initial radiological investigations were inconclusive, prompting a contrast-enhanced CT scan, which revealed a left paraduodenal hernia with encapsulated jejunal loops. Emergency laparotomy confirmed the diagnosis, and the hernia was repaired by reducing the bowel loops, excising the hernial sac and closing the defect. Paraduodenal hernias carry a high risk of complications such as strangulation, bowel necrosis and perforation, making early diagnosis and surgical intervention crucial. This case highlights the importance of considering internal hernias in patients with unexplained recurrent abdominal pain, particularly in the absence of previous surgeries.