Paraduodenal hernia with situs inversus abdominalis: A case report

Situs Inversus Abdominalis (SIA) & Paraduodenal Hernias (PDH) are extremely rare causes acute surgical emergencies among adults. We present a case of an adult patient with intestinal obstruction secondary to PDH through the fossa of Landzert with concurrent SIA.

A thirteen-year-old Southeast Asian female with situs inversus abdominalis due to Kartagener syndrome presented with bowel obstruction. The patient failed conservative management and required surgical intervention. A diagnostic laparoscopy was done followed by laparotomy. Intraoperatively, there was a paraduodenal mesentery defect at the duodenojejunal junction with internal herniation of the terminal ileum and caecum. Successful reduction of bowels and closure of the mesentery defect was done without any bowel resection.

Only three cases of bowel obstruction secondary to SIA have been documented in literature. This is the fourth and the only case to have concurrent paraduodenal hernia. Surgical repair of PDH is mandatory to avoid the increased risk of incarceration or strangulation however pre-operative diagnosis of PDH resembles a diagnostic challenge especially among patients with intestinal anomalies.

Intestinal malrotation is known to be the most common cause of intestinal obstruction in patients with intestinal anomalies. However, clinicians should maintain a high index of suspicion of intestinal herniation and adhesions as the cause of intestinal obstruction in such cases. Further imaging such as computed tomography (CT) scan and diagnostic laparoscopy may be beneficial provided patients have no overt signs of acute bowel ischaemia.