Laparoscopic management of strangulated paracaecal hernia causing small bowel obstruction. Case report and review of the literature

Paracaecal hernia is a rare type of internal hernia usually presenting with a picture of small bowel obstruction. In this report we present a 68-year-old woman who was admitted with colicky lower abdominal pain, vomiting and abdominal distention. A computed tomography scan of her abdomen and pelvis demonstrated multiple dilated small bowel loops with a transition point in the right iliac fossa. After a trial of conservative treatment, the patient was taken to theatre where she underwent laparoscopic reduction of a strangulated paracaecal hernia. The patient had an uneventful post-operative recovery and was discharged home. Despite being a rare cause for small intestinal obstruction, this should be part of the differential diagnosis especially in the absence of previous abdominal operations. Early recognition and prompt surgical treatment is the key to prevent complications. A laparoscopic approach is feasible if expertise is available.