[Left paraduodenal hernia with particular evolution]

Paraduodenal hernia is a rare situation, less than 400 cases being published in literature. This condition is difficult to explore, diagnose appear within an occlusive syndrome. The etiopathology involves perturbation of intestinal rotation during the intrauterine life, producing paraduodenal fossa, which generates conditions for internal hernias and occlusive situations. We present the case of a 36 years old woman with chronic epigastric pain, diagnosed as duodenal ulcer, later as acute pancreatitis and in the end as high occlusion syndrome. Open laparotomy was performed, uncovering a strangulated left paraduodenal hernia, with severe pathologic lesions of the intestinal loops. Kelotomy and pure-string suture of parietal defect was performed. Post-operative evolution has been difficult with hepatic failure with coagulopathy and diffuse intestinal hemorrhage, threatening the patient's life. Intensive care lead eventually to a favorable condition. The rarity of this disease, difficulty of diagnosis and the particular evolution were the reasons to present this rare case.