A Rare Case of Small Bowel Obstruction Due to Paraduodenal Hernia

Patient: Female, 24 Final Diagnosis: Paraduodenal hernia Symptoms: Abdominal pain • Bowel obstruction Medication: — Clinical Procedure: Surgical excision of the sac and release of adhesion Specialty: Surgery OBJECTIVE: Challenging differential diagnosis BACKGROUND: Paraduodenal hernia, or mesocolic hernia, is a rare congenital form of internal abdominal hernia, and is classified into right and left, with left paraduodenal hernia being more common than right. Patients can have non-specific symptoms and signs, which make the diagnosis challenging. However, patients may present with obstruction or ischemia requiring emergency surgery. This report is of a case of left paraduodenal hernia in a 24-year-old woman who presented with acute abdominal pain at two-weeks post-partum and who was managed with open surgery with good clinical outcome. CASE REPORT: A 24-year-old Saudi woman presented with recurrent chronic abdominal pain that was managed conservatively for the previous six years. At two-weeks post-partum, she presented with acute abdominal pain, vomiting, and constipation. Computed tomography (CT) of the abdomen showed a left paraduodenal hernia. The patient underwent timely open laparotomy due to the presence of bowel dilatation. Her postoperative recovery was uneventful. CONCLUSIONS: Although rare, this case has shown that paraduodenal hernia can cause intestinal obstruction. CT imaging increases the chance of early diagnosis and timely surgery. Although laparoscopic surgical repair may be preferable in some cases, this patient underwent successful open repair.