Laparoscopic management of a small bowel obstruction caused by an unusual pericecal hernia: Case report

INTRODUCTION: Pericecal hernia is a rare type of internal hernia and may present with unspecific signs and symptoms. Thus, preoperative recognition of pericecal hernias can be challenging and difficult. CASE PRESENTATION: We present a case of pericecal hernia in a rare location that was managed laparoscopically. A 63-year-old medically free gentleman presented to the emergency room with clinical and radiographic evidence of small bowel obstruction. An abdominal computed tomographic scan showed diffuse small bowel dilation and a transitional zone at the distal illeal loop near the ileocecal junction. The patient was admitted and started on conservative management. Two days later, there was no improvement in the patient’s situation, and the patient underwent laparoscopic exploration where part of the distal ileum was seen going through a mesenteric defect superior to the ileocecal valve. The herniated bowel was reduced, and the hernia orifice was closed with sutures. The patient was discharged at day 9 postoperatively with excellent clinical and radiographic findings during the postoperative period. DISCUSSION: Pericecal hernia in the superior ileocecal recess is the least common location for this type of hernia. Previously, laparoscopic management of small bowel obstruction was not recommended. However, recent evidence has shown excellent outcomes of laparoscopic management of pericecal hernia. CONCLUSION: In pericecal hernia, having a high index of suspicion may help prevent delayed diagnosis and management. Laparoscopic exploration is a safe and acceptable modality for the diagnosis and treatment of small bowel obstruction due to pericecal hernias.