A Rare Case of Small Bowel Obstruction Due to Paraduodenal Hernia

Abstract

Patient: Female, 24Final Diagnosis: Paraduodenal herniaSymptoms: Abdominal pain • Bowel obstructionMedication: —Clinical Procedure: Surgical excision of the sac and release of adhesionSpecialty: SurgeryObjective:Challenging differential diagnosisBackground:Paraduodenal hernia, or mesocolic hernia, is a rare congenital form of internal abdominal hernia, and is classified into right and left, with left paraduodenal hernia being more common than right. Patients can have non-specific symptoms and signs, which make the diagnosis challenging. However, patients may present with obstruction or ischemia requiring emergency surgery. This report is of a case of left paraduodenal hernia in a 24-year-old woman who presented with acute abdominal pain at two-weeks post-partum and who was managed with open surgery with good clinical outcome.Case Report:A 24-year-old Saudi woman presented with recurrent chronic abdominal pain that was managed conservatively for the previous six years. At two-weeks post-partum, she presented with acute abdominal pain, vomiting, and constipation. Computed tomography (CT) of the abdomen showed a left paraduodenal hernia. The patient underwent timely open laparotomy due to the presence of bowel dilatation. Her postoperative recovery was uneventful.Conclusions:Although rare, this case has shown that paraduodenal hernia can cause intestinal obstruction. CT imaging increases the chance of early diagnosis and timely surgery. Although laparoscopic surgical repair may be preferable in some cases, this patient underwent successful open repair.

Left Paraduodenal Hernia Presenting as Closed Loop Jejunal Obstruction in a Young Female: An Enigmatic and Perilous Differential of Acute Abdomen

“…Satapara et al and Al Otaibi et al reported LPDH in young female patients. 6,7 Kozman and Fisher reported a case of LPDH postlaparoscopic appendectomy in a 15-yearold female patient. 8 We report a case of LPDH in an atypical patient profile, that is, young and female.…”

Left Paraduodenal Hernia as a Rare Cause of Intestinal Obstruction-Laparoscopic Management

“…Para-duodenal hernia is dened as abnormal protrusion of viscera into the para-duodenal fossa and results in less than 1% of all cases of small intestinal obstruction [1].…”

“…Left PDH [75%] is commoner than right PDH [25%] [1].Embryological development of right para-duodenal hernia consists of non-rotation of pre-arterial segment of midgut [2], whereas development of left PDH consists of normal rotation of gut but abnormal xation of the descending mesocolon to the posterior abdominal wall, which leads to formation of an unsupported area[Landzert's fossa] and herniation of contents into it. This lies lateral to the fourth part of the duodenum, posterior to the inferior mesenteric vein [IMV], the ascending branch of the left colic artery [LCA] and anterior to posterior parietal peritoneum [2].…”

Broad ligament hernia: Two contrasting ways to a common goal – Two case reports with review of literature

“…Intestinal obstruction is a common clinical condition encountered in emergency rooms around the world. Internal herniae figure among it's rare causes and account for just about 1–2% of all cases [1] . Internal herniae are protrusions of the viscera through defects in the mesentery or peritoneum, contained within the abdomen.…”

“…Internal herniae are protrusions of the viscera through defects in the mesentery or peritoneum, contained within the abdomen. Broad ligament hernia (BLH) is a rare type of internal hernia and accounts for just 4% of all internal hernias [1] . It is difficult to diagnose due to it's vague symptomatology [2] .…”