It was the best of times, it was the worst of times…’, thus began Charles Dickens in his classic novel ‘A Tale Of Two Cities’. We revisit right and left Paraduodenal herniae(PDH) in this article. Our ‘two cities’ are the fossae of Waldeyer and Landzert respectively. We think the times are the best as of present day, since cutting edge diagnostic tools(CECT abdomen) offer us an unambiguous diagnosis of PDH. Also the advent of minimal access surgery from the last decade of the twentieth century onwards, has afforded us the luxury of treating PDH by laparoscopy. However these are also the worst of times since PDH, though rare, constitutes 53% of all internal hernias and if undiagnosed, can increase mortality rate upto 20%[1]. In this article, we attempt to make a side by side comparison of right and left PDH vis-à-vis their embryology, diagnosis, laparoscopic ‘first look appearance’, surgical therapy and the endresult.

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Background: Intestinal obstruction due to right paraduodenal hernia in early postpartum period is rare. There is only one published case report on left-sided paraduodenal hernia (PDH) in early postpartum period, which was treated by open surgery [1]. However, we would like to present first ever case of right-sided PDH causing acute small bowel obstruction in early postpartum period, which was treated laparoscopically. Case Presentation: Our patient was a 29-year-old female who had undergone full-term normal delivery 4 days prior. She presented with acute small bowel obstruction to the emergency ward. Right PDH was diagnosed on contrast-enhanced abdominal computed tomography. She underwent laparoscopic repair. Right PDH is a congenital condition caused by incomplete rotation of the midgut in early embryological developmental phase. In our patient, increased intra-abdominal pressure during gestation probably forced more and more bowel loops to enter and get entrapped into the pre-existing defect. Conclusion: Right PDH is a rare entity and can rarely cause acute intestinal obstruction in immediate postpartum period.

We report a case of 33 years old male, presented with colicky pain in left upper abdomen on and off since 15 days, one episode of bilious vomiting and abdominal distension with constipation since 2 days. A case of intestinal obstruction was diagnosed as a Left Paraduodenal Hernia[PDH] on contrast enhanced computed tomography of the abdomen(CECT) and managed with laparoscopic repair. Through this case report, we want to give the message that PDH though rare should be considered as a differential diagnosis in a case of intestinal obstruction and can be managed successfully with laparoscopic approach even in an emergency situation.