Complicated Right Paraduodenal Hernia - A Case Report

Abstract

Paraduodenal hernia, a rare congenital anomaly that arises from an error of rotation of the midgut, is the most common type of intra-abdominal hernia. There are two types, right and left paraduodenal hernia, the right being less common. We report the case of a 41-year-old patient with a right paraduodenal hernia who presented with two days history of continuous pain abdomen with multiple episodes of vomiting. Patient was decided to undergo laparotomy in view of increasing abdominal pain and development of peritonitis. In a planned laparotomy, herniation of the small bowel loops through the fossa of Waldeyer, behind the ascending mesocolon was found which was gangrenous with prolapse of a few gangrenous loops into the peritoneal cavity. The gangrenous bowel resected, and an end to end jejunoileostomy performed.

Right para‐duodenal hernia presenting as an abdominal mass with small bowel obstruction

“…The patient had no post‐operative complications and was discharged. The treatment of internal hernias needs to be quick as the delay may lead to ominous complications such as obstruction and gangrene 4 …”

“…Many cases are incidentally diagnosed on table and rest present as bowel obstruction. The obstructed cases can progress to gangrene and perforation 4 . Thus, prompt diagnosis and treatment of internal hernias is of paramount importance.…”

“…The multiple and vague symptoms often lead to the diagnosis of non‐specific abdominal pain and the patient is mistreated for a long time till complications set in. If the patient is asymptomatic, treatment should begin as soon as feasible after diagnosis; if the patient has complications, treatment should begin simultaneously 4 . Surgical options for treatment include open or laparoscopic procedures that reduce the herniated contents and close the defect 3 .…”

“…The obstructed cases can progress to gangrene and perforation. 4 Thus, prompt diagnosis and treatment of internal hernias is of paramount importance.…”

“…If the patient is asymptomatic, treatment should begin as soon as feasible after diagnosis; if the patient has complications, treatment should begin simultaneously. 4 Surgical options for treatment include open or laparoscopic procedures that reduce the herniated contents and close the defect. 3 When the defect is large, mesh placement has been reported.…”