Left Paraduodenal Hernia Presenting as Closed Loop Jejunal Obstruction in a Young Female: An Enigmatic and Perilous Differential of Acute Abdomen

Internal hernia is a rare cause of intestinal obstruction, accounting for <2% of cases with paraduodenal type being the most common. An internal hernia, mostly acquired, develops due to protuberance of the intestine through a gap in the peritoneum or mesentery formed as a result of an antecedent abdominal operation such as gastric bypass or liver transplant, ischemic injury, peritonitis, or trauma. Paraduodenal hernias (PDHs) are congenital anomalies, secondary to a failed fusion of mesentery with parietal peritoneum along with rotational midgut errors, causing the evolution of potential space for herniation within the left paraduodenal fossa. Primary internal hernias can have a varied clinical presentation and cause significant mortality and morbidity if left untreated. We report the case of a 20-year-old female with chronic pain in abdomen and intestinal obstruction due to left PDH (LPDH). The prompt diagnosis led to timely exploration and reduction of entrapped jejunum, with prudent closure of the hiatus, while circumventing any injury to the adjacent mesenteric circulation. No postoperative ileus arose, and recovery was uneventful.

Acute Adult Jejuno-Jejunal Intussusception Caused by a Giant Lipoma

Acute abdominal pain secondary to intussusception is rare in adults and mainly caused by malignancy (70-90%), whereas in childhood intussusception’s etiology is mostly idiopathic (90% of cases). Gastrointestinal lipomas, especially in small bowel, represent an unusual cause of intussusception with complete intestinal obstruction or bleeding (acute or chronic) from mucosal ulceration. In acute settings, computed tomography (CT) should be confidently considered the gold standard for diagnosis. In adulthood, surgical management of acute symptomatic intussusception caused by lipoma is mandatory. We report a case of complete jejunal obstruction with intussusception due to 5 cm submucosal lipoma.

Isolated myeloid sarcoma presenting with small bowel obstruction: a case report

Background Myeloid sarcoma (MS) is a solid tumor consisting of myeloid blasts or immature myeloid cells, which are unusual outside the bone marrow. Case presentation We present a rare case of isolated myeloid sarcoma of the small bowel in a 54-year-old man who was admitted to our hospital with repeated symptoms of intestinal obstruction. A small bowel series via an ileus tube revealed severe jejunal obstruction. Computed tomography revealed that the obstruction was likely caused by a jejunal tumor. The patient underwent laparoscopy-assisted partial resection of the jejunum with lymphadenectomy. Histopathological examination of the surgical specimen confirmed that MS had been responsible for the obstruction. Conclusions Patients with MS require systemic chemotherapy, as do patients with acute myeloid leukemia. Hence, an early, accurate diagnosis is imperative for treating this malignancy. It is also important to list MS in the differential diagnosis of a small bowel tumor, even in nonleukemic patients.

Stage IV jejunal adenocarcinoma: a multimodal therapeutic success story

Small bowel adenocarcinoma is rare with an incidence of 2.6 in 100 000 patients. Diagnosis is often fortuitous and usually presents late. We present the case of a 36-year-old male who attended the emergency department with worsening abdominal discomfort. A computed tomography scan showed high-grade jejunal obstruction secondary to a jejunal mass suspicious for carcinoma with disseminated peritoneal carcinomatosis and hepatic metastases. Following a conservative approach, his obstruction settled. He commenced on a total of 12 cycles of FOLFOX (folinic acid, fluorouracil and oxaliplatin) and bevacizumab. After re-presenting with intermittent intussusception, a decision for surgical resection was made. On laparoscopy, there was no evidence of hepatic metastases or peritoneal carcinomatosis. A jejunal resection was carried out with an uneventful postoperative period. The patient remains disease free. Despite presenting with an advanced stage, a multimodal approach to these rare tumors may yield surprising and optimistic outcomes.

Congenital band adhesion causing a proximal jejunal obstruction: an uncommon presentation and diagnosis

A 20-year-old woman with no medical or surgical history presented with acute onset crampy abdominal pain on a background of uninvestigated similar chronic abdominal pain. She became obstructed during her admission and a contrast swallow showed a complete obstruction at the level of the proximal jejunum. A diagnostic laparoscopy revealed a congenital band adhesion from the greater omentum to the proximal jejunum to be the cause, and dissection of the band relieved her obstruction. This case presents a rare cause of mechanical obstruction, and highlights the seriousness of investigating obstructive symptoms even in atypical patient populations.