Intestine get strangulated most commonly in which space
a. Mesocolic hernias are unusual congenital hernias in which the small intestine herniates behind the mesocolon.
b. They result from abnormal rotation of the midgut and have been categorized as either right or left.
c. A right mesocolic hernia occurs when the prearterial limb of the midgut loop fails to rotate around the superior mesenteric artery.
d. This results in the majority of the small intestine remaining to the right of the superior mesenteric artery.
e. Normal counterclockwise rotation of the cecum and proximal colon into the right side of the abdomen and its fixation to the posterolateral peritoneum cause the small intestine to become trapped behind the mesentery of the right side of the colon.
f. The ileocolic, right colic, and middle colic vessels lie within the anterior wall of the sac, and the superior mesenteric artery courses along the medial border of the neck of the hernia.
g. It is postulated that left mesocolic hernias occur as a consequence of in utero herniation of the small intestine between the inferior mesenteric vein and the posterior parietal attachments of the descending mesocolon to the retroperitoneum.
h. The inferior mesenteric artery and vein are integral components of the hernia sac. About 75% of mesocolic hernias occur on the left side.
i. Patients with paraduodenal hernias most commonly present with symptoms of acute or chronic small bowel obstruction. Barium radiographs will demonstrate displacement of the small intestine to the left or the right side of the abdomen.
j. CT with IV contrast may demonstrate displacement of the mesenteric vessels and evidence of intestinal obstruction, if present.
k. The operative management of patients with a right mesocolic hernia involves incision of the lateral peritoneal reflections along the right colon with reflection of the right colon and cecum to the left.
l. Opening the neck of the hernia will injure the superior mesenteric vessels and fail to free the herniated bowel