Incidental paraduodenal hernia found during laparoscopic colectomy

Area of Science:

• Gastroenterology and Surgical Innovation

Background:

• A 60-year-old male presented with a history of diverticulitis, constipation, and abdominal pain.
• Preoperative imaging diagnosed diverticular disease, with no other abnormalities noted.

Observation:

• Laparoscopic colon resection revealed an unexpected right paraduodenal hernia.
• The small intestine was herniated under the ascending colon and hepatic flexure, complicating the planned surgery.

Findings:

• Conversion to open laparotomy was necessary for safe hernia reduction and sac excision.
• Surgical interventions included lysis of adhesions for duodenal obstruction, a Ladd's procedure for malrotation, and sigmoid colectomy.
• The patient experienced prolonged ileus but recovered after 14 days.

Implications:

• This case highlights the importance of considering rare congenital anomalies like paraduodenal hernias in abdominal surgery.
• Successful management involved a multi-step surgical approach, including correction of malrotation.
• The patient's asymptomatic recovery underscores the feasibility of addressing complex hernias concurrently with planned resections.