Left paraduodenal hernia containing three small bowel loops: A rare cause of closed loop obstruction - A case report.

INTRODUCTION AND IMPORTANCE

Paraduodenal hernias (PDH) are the most common type of internal hernia, accounting for 53 % of cases, but remain a rare cause of intestinal obstruction overall. Left PDH, comprising about 75 % of all PDHs, can present with vague gastrointestinal symptoms or acute obstruction, with a high risk of strangulation and bowel ischemia. Early diagnosis and prompt surgical management are essential to reduce morbidity and mortality.

CASE PRESENTATION

A 51-year-old male presented with abdominal distention, vague abdominal pain, bilious vomiting, and inability to pass stool or flatus. Contrast-enhanced computed tomography revealed a closed-loop obstruction due to a left PDH. Emergency laparotomy showed herniation of jejunal and ileal loops with a 3 cm segment of nonviable jejunum, which was resected. An end-to-end anastomosis and primary repair of the defect were performed. The postoperative course was uneventful, and the patient remained symptom-free at the six-month follow-up.

CLINICAL DISCUSSION

Left PDH arises from congenital defects in the mesocolon, typically through the fossa of Landzert. Diagnosis is challenging due to nonspecific symptoms, but can be accurately made with CT imaging. Surgical intervention-open or laparoscopic-is required due to the high risk of complications. The approach depends on clinical urgency and available expertise.

CONCLUSION

Left PDH, though rare, must be considered in cases of unexplained obstruction, especially in a virgin abdomen. Early CT diagnosis and prompt surgical intervention are vital to reducing morbidity and mortality. The surgical approach should be tailored to patient stability and available expertise.