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. 2018:53:29-31.
doi: 10.1016/j.ijscr.2018.10.018. Epub 2018 Oct 12.

Small bowel obstruction secondary to left paraduodenal hernia: A case report and literature review

Youssef Sleiman  1 , Alaa El-Kheir  2 , Melody El-Khoury  2 , Omar Hamdach  2 , Layla Ismail  3 , Mustafa Allouch  2
Affiliations

Small bowel obstruction secondary to left paraduodenal hernia: A case report and literature review

Youssef Sleiman et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: Internal hernias are uncommon and are defined by the protrusion of a viscus through intraperitoneal defects. Left paraduodenal hernias (LPDH) are the most common type of congenital internal hernia (CIH). We report a clinical case of a patient with a small bowel obstruction (SBO) due to a LPDH.

Case presentation: An elderly patient, with negative surgical history, presented to the emergency room with abdominal pain and vomiting. Clinical and radiologic investigations were consistent with SBO due to an internal hernia. During laparotomy, a large LPDH containing dilated small bowel loops was identified. The hernia contents were reduced and the opening was closed with non-absorbable sutures. The post-operative course was uneventful without signs of recurrence at follow up.

Discussion: LPDH result from absence of retroperitoneal fixation of the descending colon mesentery. Usually, patients are asymptomatic and LPDH are incidental findings detected on imaging and/or during laparotomy. However, LPDH may lead to acute SBO therefore a high index of clinical suspicion and preoperative imaging is crucial to make an early diagnosis.

Conclusion: CIH is a rare condition due to embryologic developmental abnormalities. Their diagnosis is based on pathognomonic findings on computed tomography scanner (CTscan). Surgical treatment is the mainstay treatment. Delay diagnosis of strangulated CIH is associated with significant morbidity andmortality.

Keywords: Internal hernia; Intestinal obstruction; Landzert fossa; Left paraduodenal hernia.

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Figures

Fig. 1
Fig. 1
A and 1B: CT scan shows dilated small bowel loops with transition zone located left to the Treitz ligament (green arrow) and saclike appearance (green circle).
Fig. 2
Fig. 2
Intra-operative photograph showing the hernia sac in landzert fossa posterior to the descending mesocolon that contains dilated small bowel loops.
Fig. 3
Fig. 3
Intra-operative photograph showing the hernia orifice (white arrow).
See this image and copyright information in PMC

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