Presentation
Acute abdomen and vomiting.
Patient Data
In the right hypochondrium, there is abnormal distension of some jejunal loops with air-fluid levels.
The jejunal loops and Treitz are on the right side, near the liver, with "small bowel feces" sign and hypertrophy of the Kerckring valves; it is associated whirl sign of the mesenteric vessels with modest peritoneal effusion.
The jejunal loops are absent on the left.
Case Discussion
Paraduodenal hernias are a rare type of hernia that results from malrotation of the small intestine during embryonic life. Paraduodenal hernias can arise on the right or on the left.
Clinical manifestations can be variable and non-specific, from asymptomatic, to occlusion and intestinal ischemia. The average age of onset is about 40 years.
In this case, the diagnosis was confirmed surgically.
Operative report
Open laparoscopy
There are parietal adhesions from previous interventions. The omentum moves upward and jejunal loops are visible at the level of the paraduodenal region.
Laparotomy
Right paraduodenal hernia sac with some jejunal loops with slight ischemic change. The hernia sac is released and the loops are repositioned through the ligament of Treitz.
Case courtesy Dr.ssa Eleonora Renzi.
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