Clinical features of paraduodenal hernia

Fatal Bowel Obstruction Due to Paraduodenal Hernia: A Case Report

A paraduodenal hernia is a rare type of hernia, however it is the most common type of internal hernias. It can develop after surgery, trauma, or be congenital. Paraduodenal hernias are rare in children. Clinical presentation is nonspecific. Patients range from being asymptomatic to presenting with clinical symptoms associated with small bowel obstructions. Diagnostic tools such as X-ray, plain abdominal radiography, and computed tomography may be used to diagnose paraduodenal hernias. Described is the case of a 5-year-old female who died suddenly of a bowel obstruction due to a paraduodenal hernia found at postmortem examination. In the hours prior to death, she reported stomach pain, vomiting, and later developed a fever. Postmortem CT study showed free fluid in the abdomen and bowel distention. Internal examination showed an obstructed bowel with ischemic sections extending from the distal portions of the small bowel up to the proximal portions of the transverse colon. The ischemic portions were entrapped within a clear membranous sac within the abdominal cavity. The sac was concluded to be a paraduodenal hernia. Paraduodenal hernias are rare and difficult to diagnose but they must be considered in the diagnostic process, as without surgical intervention the mortality rate can be high.

Left Paraduodenal Hernia: A Cause of Double Intestinal Obstruction

Paraduodenal hernias are of congenital origin and may present with symptoms and signs of small intestinal obstruction. These hernias are rare in our practice, and a definitive preoperative diagnosis is often not made as the symptoms are not specific. Early assessment and prompt and adequate resuscitation and surgery obviate the risk of strangulation and intestinal resection. This report highlights a rare cause of intestinal obstruction in a young male who presents with all the classical features of obstruction: colicky abdominal pain, distension, vomiting, and inability to pass stool or flatus. The diagnosis of paraduodenal hernia was made intraoperatively. We do not routinely request for barium examination or abdominal computed tomography scan in acute abdominal pain. These modalities can suggest a preoperative diagnosis.