Right paraduodenal hernia with extensive bowel gangrene treated with staged surgery: a Bogota bag followed by resection in a low-resource setting

Abstract

We report a case of right paraduodenal hernia with strangulation of almost the entire small bowel at presentation. Since resection of all bowel of doubtful viability would have resulted in too little residual length to sustain life, a Bogota bag was fashioned using transparent plastic material from an urine drainage bag and the patient monitored intensively for 18 hours. At re-laparotomy, clear demarcation lines had formed with adequate length of viable bowel (100 cm) and resection with anastomosis was done with a good outcome on follow-up, 9 months after surgery. Our description of a rare cause of strangulated intestinal obstruction and a novel method of maximising length of viable bowel is reported for its successful outcome in a low-resource setting.

Keywords: adult intensive care; gastrointestinal surgery; global health; nutrition and metabolism.

Figure 1

Small bowel being reduced from the right paraduodenal hernia.

Figure 2

Bowel inside the ‘Bogota bag’ fashioned from plastic material obtained from a sterile urine drainage bag.

Figure 3

Anatomy of right paraduodenal hernia, showing bowel entering the fossa of Waldeyer with the superior mesenteric vessels along the medial border of the opening. (Reprinted by permission from Copyright Clearance Center: Springer Nature eBook: Dynamic Radiology of the Abdomen, 5th edition 2005, Morton E Myers, Internal Abdominal Hernias, 715; ISBN 978-0-387-21804-5).