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Obstructed Right Paraduodenal Hernia: An Unusual Cause of Small Bowel Gangrene

Dimpy Shah1, Nitin Borle1, Sachin Suryawanshi1

  • 1General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, IND.

Cureus
|October 14, 2024
PubMed

Insights

Right-sided paraduodenal hernias are rare and challenging to diagnose, often leading to small bowel obstruction. This case highlights the critical need for early diagnosis and surgical intervention to prevent fatal outcomes in patients with strangulated paraduodenal hernias.

Area of Science:

  • Gastroenterology
  • Surgical Pathology
  • Abdominal Imaging

Background:

  • Paraduodenal hernias, particularly right-sided variants, are exceptionally rare congenital abnormalities.
  • Their uncommon presentation frequently leads to diagnostic challenges and delayed treatment.
  • Complications such as strangulation or perforation significantly worsen patient prognosis.

Observation:

  • A 15-year-old male presented with acute, severe colicky abdominal pain.
  • Computed tomography revealed acute small bowel obstruction.
  • Laparotomy identified gangrenous small bowel loops obstructed within a sac at the duodenojejunal flexure, indicative of a strangulated right paraduodenal hernia.

Findings:

  • The patient required extensive small bowel resection due to extensive gangrene.
  • The patient succumbed to complications in the postoperative period.
  • This case underscores the diagnostic complexity and potential fatality of strangulated right paraduodenal hernias.

Implications:

  • Early diagnosis and prompt surgical intervention are crucial for improving outcomes in paraduodenal hernia cases.
  • This rare condition necessitates a high index of suspicion in patients presenting with small bowel obstruction.
  • Effective management strategies are vital to mitigate the severe morbidity and mortality associated with complicated paraduodenal hernias.
Keywords:
internal herniaright paraduodenal herniasmall bowel obstructionsmall bowel resectionsuperior mesentric artery

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