A spontaneous paracecal herniation: a rare form of an uncommon case

Paracecal hernias are a rare form of internal hernias. This is a case of a spontaneous paracecal retroperitoneal hernia in an elderly patient. A 73-year-old male, a known patient of adenocarcinoma of the rectum, who had undergone neoadjuvant radiotherapy and chemotherapy a year ago, presented with a 2-day-history of exacerbated colicky peri-umbilical and right-sided non-radiating abdominal pain, with associated progressive abdominal distension, which were aggravated by feeding. A contrasted abdominal computed tomography scan showed features of small bowel obstruction. An exploratory laparotomy revealed herniation of gangrenous small bowel ~30 cm through a small, tight opening just below the base of the cecum. Resection and anastomosis and closure of the retroperitoneal pouch were done. Patient recovered and was discharged on the fourth post-operative day. Spontaneous retroperitoneal hernias can occur in elderly patients with additional risk factors like neoplasms, with a high risk of bowel ischemia, hence the urgent need for surgical intervention.