A Case of Preoperatively Diagnosed Right Paraduodenal Hernia

Hiromitsu Nagata, Naoki Yokoo, Yasuhito Kitakado, Takashi Shiroko, Takahito Adachi, Takahiro Yoshida, Katsuaki Ura, Yoshihiro Tanaka and Shinya Hamasu

Department of Surgery, Takayama Red Cross Hospital

We report a case of right paraduodenal hernia causing strangulation of small intestine. A 35-year-old man seen for severe abdominal pain was found in abdominal enhanced computed tomography (CT) to have the small intestine extended into the retroperitoneal space where it displaced the superior mesenteric artery to the front, and mesenterium and mesenteric vessels in linear structure crossed. An ileus tube moved abnormally in the descending part of the duodenum when inserted and contrast study of ileus tube enterography showed complete obstruction of the upper gastrointestinal tract.
Laparotomy was conduced for a diagnosis of internal hernia (right paraduodenal hernia) causing strangulation of the small intestine. About 1 meter small intestine was incarcerated in the hernia sac from the descending part of the duodenum. A portion of small intestine also prolapsed from a hernia opening and was strangulated at the opening. The incarcerated small intestine was repositioned and the opening closed. Abdominal enhanced CT and ileus tube enterography were helpful in preoperative diagnosis, enabling early diagnosis. Paraduodenal hernia should thus be taken into account in the diagnosis of intestinal obstruction, particularly in patients without a history of laparotomy.

Key words
internal hernia, right paraduodenal hernia, strangulated hernia

Reprint requests
Hiromitsu Nagata Department of Surgery, Takayama Red Cross Hospital
3-11 Tenman-cho, Takayama, 506-8550 JAPAN

Accepted
March 27, 2002

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