A CASE OF STRANGULATED ILEUS DUE TO A RIGHT PARADUODENAL HERNIA

Abstract

Recently we experienced a case of strangulated ileus due to a right paraduodenal hernia. A 16-year-old woman was seen at the hospital because of a severe abdominal pain. There were distention in the right side of the abdomen, as well as tenderness and rebound tenderness. Enhanced CT revealed not-visualized small intestine and a large quantity of ascites only in the right side of the abdomen. Under a diagnosis of strangulated ileus caused by an internal hernia, an emergency operation was carried out. On laparotomy, a large quantity of yellow ascites was confirmed and a portion from the origin of the jejunum to terminal ileum incarcerated into a portion between the mesentery of the ascending colon and retroperitoneum where should be physiologically adhered in normal state. In addition, a portion of small intestine prolapsed from a hernia openning and was strangulatred at the openning to be necrotized. When the hernia sac was incised and replaced, it was found that the duodenum did not fixed and the Treitz ligament was not formed. As to the small intestine, circulatory insufficiency was noted from one meter distant from the jejunum origin to 50cm oral side from the ileum end, involving necrosed parts in places. So massive excision of the small intestine was carried out. Postoperative course was uneventful. The patient was discharged from the hospital on the 10th hospital day.