AB180. SOH25_AB_147. Right paraduodenal hernia—case report and diagnostic dilemma

Background: We reported a retrospective study of a case of right PDH as a rare cause of intestinal obstruction. PDHs are a rare entity and caused by incomplete rotation of mid-gut, which is attributable to fossae formation and hence classified as left and right PDH, accounting for 75% and 25%, respectively. Herniation through Landzert fossae results in a left para-duodenal hernia with the primary constituents of the hernia sac being the inferior mesenteric artery and vein. For right para-duodenal hernia, herniation occurs through Waldeyer fossae with the main contents of the hernia sac being the ilio-colic, right colic, and middle colic vessels. Often a diagnostic challenge but can be diagnosed on contrast enhanced CT scan and timely surgical treatment can be performed open or laparoscopically.

Case Description: We report a case of a 73-year-old male presented with bowel obstruction, diagnosed on computed tomography (CT) scan as right-sided paraduodenal hernia (PDH). He required laparotomy and reduction of contents of hernia without any resection and closure of peritoneal defect with polydioxone sulphate (PDS) 2.0. Postoperative recovery was uneventful, and the patient was discharged home the following week.

Conclusions: Internal hernias are rare and a diagnostic dilemma for clinicians and radiologists. Hardly any cases are reported in the literature, the total reported cases would merely be 500. PDHs accounts for half of the cases and 0.2–0.9% present clinically as intestinal obstruction.

Keywords: Paraduodenal hernia; internal hernias; small bowel obstruction; case report