Case Report: Right paraduodenal hernia – a unique case of rare internal hernia presenting as acute small bowel obstruction

Paraduodenal hernia, a rare internal hernia, is an uncommon cause of small bowel obstruction. We present a case report of a 45-year-old male presenting to the emergency department with complaints suggestive of small bowel obstruction. Abdominal plain X-ray was also suggestive of small bowel obstruction. Emergency laparotomy showed intraoperative findings of right sided paraduodenal hernia with dilated small bowel. Postoperative hospital stay was uneventful and the patient was doing well during 24 months of follow up with no active complaints. Paraduodenal hernia should be considered as part of the differential diagnosis of small bowel obstruction in patients who have repeated attacks and no prior history of abdominal surgery. Surgeons need to have an astute clinical acumen in diagnosing internal hernias to avoid repercussions and fatal events.

Right paraduodenal hernia accompanying superior mesenteric vein thrombosis: a rare case

A 59-year-old man with abdominal pain was admitted to the emergency department. Investigations had revealed a right-sided paraduodenal hernia and superior mesenteric vein (SMV) twisting around the superior mesenteric artery in rotation, the ‘whirlpool sign’. Owing to the increasing severity of abdominal pain and the presence of SMV thrombosis complicated with strangulated paraduodenal herniation associated with high mortality rates, diagnostic laparoscopy was performed. Resection of the intestines was not needed and paraduodenal hernia was repaired. The patient was uneventfully discharged.

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

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.

Right paraduodenal hernia, rare cause of gangrene bowel: case report with review of literature

A right paraduodenal hernia includes small bowel trapped within a peritoneal sac between the right and transverse colon, positioned right of midline, with the hernia sac opening to the left at the ligament of treitz, with either the superior mesenteric or ileo-colic artery at the anterior aspect of the sac. Patients with PDH often present with signs and symptoms of obstruction and/or bowel gangrene. We report a case of a 50 year old male presenting with small bowel ischaemia due to right paraduodenal hernia. Patient presented with chief complaints of colicky abdominal pain since two days and abdominal distension, and altered sensorium since one day. Abdominal ultrasonography showed dilated small bowel loops, and CT scan of abdomen was suggestive of clustering of small bowel loops with proximal dilatation. Exploratory laparotomy revealed a right PDH with a strangulated loop of 160 cm of small bowel within. The peritoneum at the ligament of Treitz was lax. The DJ flexure showed gangrenous changes along the anti-mesenteric edge. Resection and anastomosis of small bowel was done along with wedge resection of the DJ flexure, followed by feeding jejunostomy. The sac was opened up wide and plicated over itself to prevent recurrences. Perioperative course was uneventful, and patient discharged on post op day 10. Jejunostomy tube was removed after one week. Patient is being followed up at OPD level with close surveillance to prevent nutritional deficiency due to short gut syndrome. A vigilant mind is of utmost importance to suspect and diagnose paraduodenal hernia to limit morbidity and mortality.