Right paraduodenal hernia complicated with small bowel obstruction and midgut rotation: a case report

Right paraduodenal hernia is a rare congenital internal hernia resulting from abnormal midgut rotation. Although paraduodenal hernias represent the most common type of congenital internal hernia, the right-sided variant is an uncommon cause of small bowel obstruction and is often challenging to diagnose preoperatively. We report the case of a 46-year-old woman who presented with a 48-hour history of acute abdominal pain, nausea, and vomiting, without any prior history of abdominal surgery. Physical examination revealed tenderness in the epigastric and mesogastric regions without signs of peritonitis, while laboratory findings showed leukocytosis. Plain abdominal radiography demonstrated small bowel air-fluid levels, and contrast-enhanced computed tomography suggested small bowel obstruction secondary to an internal hernia. Urgent exploratory laparotomy revealed a right paraduodenal hernia through Waldeyer´s fossa with viable entrapped small bowel loops. The herniated bowel was successfully reduced, and the mesenteric defect was closed without the need for bowel resection. Right paraduodenal hernia should be considered in patients presenting with small bowel obstruction in the absence of prior abdominal surgery. Early diagnosis using computed tomography and prompt surgical intervention are crucial to prevent strangulation and ischemic complications.