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Case Reports
. 2025 Apr 14;2025(4):rjaf209.
doi: 10.1093/jscr/rjaf209. eCollection 2025 Apr.

Left paraduodenal hernia: a rare cause of gastric outlet obstruction and large bowel obstruction

Damian Broadhurst  1 , Sandra Campbell  1 , Fazain Jarral  2 , Damian Tolan  3 , Richard P Baker  1
Affiliations
Case Reports

Left paraduodenal hernia: a rare cause of gastric outlet obstruction and large bowel obstruction

Damian Broadhurst et al. J Surg Case Rep. .

Abstract

Paraduodenal hernia is a rare subset of internal hernia and an uncommon aetiology of bowel obstruction. A 50-year-old male presented with a 12 h history of severe epigastric pain and vomiting. A contrast enhanced computed tomography scan of the abdomen and pelvis demonstrated gastric outlet obstruction and large bowel obstruction due to left paraduodenal hernia involving the distal transverse colon and gastric antrum. After resuscitation, a laparotomy was performed, the bowel was reduced, the mesocolic defect repaired, and small bowel mesentery widened. The large bowel was decompressed via the appendix stump. The post-operative recovery was unremarkable. Left paraduodenal hernia is a rare condition and where seen acutely, usually presents with small bowel obstruction. Here the patient presented with a large bowel obstruction, a rare presentation of this uncommon condition. Operative intervention is mandatory in the acute setting to prevent ischaemia and perforation from strangulation of the bowel.

Keywords: emergency general surgery; internal hernia; large bowel obstruction; mesocolic hernia; paraduodenal hernia.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Axial CT image demonstrating distended transverse colon (Tx) and stomach (st).
Figure 2
Figure 2
Axial CT image displaying transverse colon in paraduodenal hernia (PDH) with resulting distension of transverse colon (Tx) and stomach (st).
Figure 3
Figure 3
Gastric outflow obstruction of stomach (st) from compression of antrum (ant) by herniated transverse colon. Hernia between arrows.
Figure 4
Figure 4
Posterior displacement of the duodenum (D4) due to herniated transverse colon.
Figure 5
Figure 5
Coronal CT image showing obstructed transverse colon (Tx) path (small dash arrow), looping posteriorly through narrow hernia neck into anterior PDH containing Tx colon segment (wide dash arrow). Stomach (st) is distended.
Figure 6
Figure 6
Intra-operative image demonstrating mesocolic defect through which the transverse colon had herniated.
See this image and copyright information in PMC

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