A CASE OF RIGHT PARADUODENAL HERNIA SHOWING TYPICAL IMAGING IN COMPUTED TOMOGRAPHY

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 64; no. 4; pp. 879 - 882
• Main Authors: TERABE, Masahiro, HATADA, Tsuyoshi, SHIGEMORI, Chika, FUJIOKA, Masaki, IRIYAMA, Keiji
• Format: Journal Article
• Language: English
• Published: Japan Surgical Association 2003
• Subjects: computed tomography
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.64.879

A 67-year-old man admitted with acute abdominal pain showed severe right abdominal tenderness with muscle guarding. Abdominal plain-film and computed tomography (CT) imaging suggested internal hernia, necessitating emergency laparotomy with a diagnosis of internal hernia strangulating the small intestine. Approximately 100 cm of small intestine 20 cm distal to the ligament of Treitz was impacted in the portion behind the mesentery of the ascending colon. The hernia orifice was the mesentericoparietal fossa. Right paraduodenal hernia is commonly associated with malrotation of the intestine. In our case, however, the intestine was normal. The hernia sac was thought to be formed by failure of mesentery of the ascending colon to fix to the retroperitoneum during the third stage of intestinal rotation. Preoperative enhanced CT was typical for right paraduodenal hernia, demonstrating encapsulated small bowel loops behind the mesentery of the ascending colon, and arteries and veins of the involved intestine behind the superior mesenteric artery.