Acute Intestinal Obstruction: A Rare Aetiology

Abstract

Internal herniation of small intestine is a very rare entity, and it poses a real diagnostic challenge clinically. Recurrent entrapment of the bowel may lead to partial to complete intestinal obstruction and eventually strangulation of the small bowel. Of this rare clinical entity, left paraduodenal hernia is more common. High index of suspicion with prompt management may prevent bowel strangulation and gangrene. We present a case of acute intestinal obstruction due to left paraduodenal hernia with malrotation of midgut in a 55-year-old male patient.

Bowel obstruction without history of laparotomy: Clinical analysis of 70 patients

“…In contrast, it was significantly difficult to preoperatively diagnose internal hernia, Meckel's diverticulum or idiopathic volvulus ( Table 5). The reason why the preoperative diagnosis of these latter three diseases is difficult is because there are no specific/confirmatory findings on CT. 13,14 The present results are supported by Omori et al, who determined 15 Regarding the intraoperative findings, strangulation occurred in 55.7% of the total 70 patients; it was not possible to avoid resection of strangulated bowel in 30.0% of these patients (Table 6). Accordingly, the strangulated patients were categorized into two groups based on whether or not bowel resection could be avoided.…”

“…The reason why the preoperative diagnosis of these latter three diseases is difficult is because there are no specific/confirmatory findings on CT . The present results are supported by Omori et al ., who determined etiology in 67% of all patients without a prior history of laparotomy; and Chatterjee et al ., who demonstrated that most internal hernias were incidentally detected during laparotomy or an autopsy …”

Acute intestinal obstruction secondary to left paraduodenal hernia: a case report and literature review

“…Literature search between 1980 and 2012 using PubMed revealed only 44 case reports before the present one [2,5,11-49] (Table  1). Median age at presentation was 47 (range of 18–82 years old) with male to female ratio of 3:1.…”

A case of a paraduodenal hernia with a concomitant mesosigmoid defect

“…There are also cases characterized by atypical symptoms [14]. So preoperative diagnosis of paraduodenal hernia possesses a real clinical challenge due its nonspecific symptoms [7].…”