Left paraduodenal hernia as a rare cause of acute abdomen

Abstract

Paraduodenal hernias are congenital internal hernias that emerge as a result of the incomplete fusion of the mesentery with the peritoneum and abnormal intestinal rotation during the stages of foetal development. A rare cause of intestinal obstruction, especially in patients with a medical history free of abdominal operations, paraduodenal hernias account for approximately half of the cases of internal hernias and are responsible for 0.2–0.9% of intestinal obstructions. We hereby report the case of a 39-year-old female patient who presented with a three-hour episode of acute epigastric pain and nausea. Physical examination revealed tenderness and guarding at the palpation of the epigastrium and the left upper quadrant. Computed tomography was suggestive of an internal hernia at the level of the Treitz ligament. Emergency laparotomy was performed and the incarcerated jejunal loops were restored back to the abdominal cavity, while the defect at the root of the mesentery was suture closed, with care not to include the inferior mesenteric vein. The post-operative period was uneventful. Though rare, paraduodenal hernias should be included in the differential diagnosis in cases of acute abdomen or upper bowel obstruction, particularly in the absence of previous abdominal surgery. Surgical treatment is similar to that indicated for any other type of hernia, and involves reduction of the hernia’s contents and elimination of the defect.