Right paraduodenal hernia in an adult patient: diagnostic approach and surgical management

Abstract

Paraduodenal hernia, a rare congenital anomaly which arises from an error of rotation of the midgut, is the most common type of intraabdominal hernia. There are two variants, right and left paraduodenal hernia, the right being less common. We report the case of a 41-year-old patient with a right paraduodenal hernia with a 6-month history of intermittent episodes of intestinal obstruction. Diagnosis was established by CT scan and upper gastrointestinal series with small bowel follow-through. In a planned laparotomy, herniation of the small bowel loops through the fossa of Waldeyer was found. Division of the lateral right attachments of the colon opened the hernia sac widely, replacing the pre- and postarterial segments of the intestine in the positions they would normally occupy at the end of the first stage of rotation during embryonic development. Six months after the surgery, after an uneventful recovery, the patient remains free of symptoms.

Keywords: Internal hernia; Intestinal obstruction; Paraduodenal hernia.

Fig. 1.

Computed abdominal tomography image with intravenous and oral contrast. The classic cluster of small bowel loops in the right upper quadrant can be seen (arrows).

Fig. 2.

Small bowel follow-through radiologic image. Contrast-filled dilated small bowel loops in the right upper aspect of the abdomen and absence of small bowel loops in the lower abdomen are depicted.

Fig. 3.

Surgical findings. A At abdominal inspection, a sac containing dilated small bowel loops lateral to the duodenum, displacing the colon inferiorly, was seen. B Dilated small bowel loops protruding through the fossa of Waldeyer. The superior mesenteric vessels are identified anteriorly.