Further, during the workup on radiological examination X – the ray abdomen was erect and showed distended bowel loops with few air-fluid levels in the right lumbar region (shown with yellow arrowheads), which was one of the positive findings of obstruction [Fig 1].

Figure 1: X-ray abdomen erect showed distended bowel loops with few air fluid levels.

USG pelvis and abdomen showed a few tiny bowel loops (jejunal) dilated, with a maximal diameter of 3.1 cm, exhibiting to and fro slow peristalsis in the left peri-umbilical (lumbar) region. There are only a few dilated small bowel loops with a maximum of 5 mm edematous thickness. However, a Doppler study demonstrated normal vascularity in the superior mesenteric vein and superior mesenteric artery. All the above findings were suggestive of closed loop small bowel obstruction and Para-duodenal hernia. Furthermore, the patient was scheduled for a contrast-enhanced CT scan (abdominal and pelvis). Findings were Distended small bowel loops (jejunum) with a max diameter of 2.9cm noted in the left paraumbilical region, which is surrounded by a sac containing mild fluid within with edematous bowel loops. There is no evidence of dilatation of proximal bowel loops and No evidence of free retroluminal air. The Mesentery surrounding the herniated bowel sac appears engorged with a twist in the mesentery f/s/o internal hernia, which is likely left paraduodenal hernia with the start of closed loop obstruction.