A rare pathology that caused high-level intestinal obstruction: Left paraduodenal hernia

Abstract

The aim of this report is to assess clinical findings and surgical treatment of left paraduodenal hernia, which is an unusual type of internal herniation, in light of the literature. The diagnosis and treatment course of a 42-year-old male patient with findings of intestinal obstruction was assessed and presented together with literature search. The patient underwent surgery with a preliminary diagnosis of intestinal obstruction and the definitive diagnosis of internal herniation was made intraoperatively. Nearly two-thirds of the small intestine was found to be herniated into the retroperitoneal space from the left paraduodenal region. Small bowel loops were pulled out of the hernia sac and anatomically positioned in the intraperitoneal area. The hernia sac was repaired primarily. The patient was discharged on the fourth postoperative day, uneventfully. Left paraduodenal hernia should be considered as a part of differential diagnosis in patients who have recurring abdominal pain episodes accompanied by symptoms suggestive of intestinal obstruction. Timely diagnosis is important to prevent complications. Reduction of hernia content followed by primary repair of the defect appears to be a safe and effective treatment.

Keywords: Paraduodenal hernia; internal hernia; intestinal obstruction.

Figure 1.

Air-fluid levels in the left upper quadrant in plain abdominal X-ray

Figure 2.

Bowel loops clustered in the left upper abdomen on abdominal computed tomography

Figure 3.

Left paraduodenal defect at laparotomy

Figure 4.

View of the defect and small bowel wiht partial impairment of vascular supply (before warming)