Presentation
Abdominal pain and constipation.
Patient Data
A cluster of dilated small bowel loops are seen adjacent to second part of duodenum with non-visualized third part of duodenum.
The bowel loops herniated through the fossa of Waldeyer with superior mesenteric artery and vein immediately anterior to the hernial orifice.
There is segmental diminishment in opacification of mesenteric arcades, interloop fluid, and mesenteric edema which may indicate impending ischemia due to suspected closed loop obstruction.
Agenesis of uterus associated with ectopic left kidney which are most likely suggesting Mayer-Rokitansky-Küster-Hauser syndrome.
Case Discussion
Paraduodenal hernias constitute the majority of all internal hernias, with predominance of the left, and in men with a ratio of about 3:1.
The right paraduodenal hernias occur frequently in cases of a non-rotated small intestine associated with a normal or incompletely rotated colon.
The right paraduodenal hernia appears as a cluster of dilated small bowel loops inferior to the transverse segment of the duodenum, with superior mesentric artery/vein located along the anterior wall of the sac with absence of the normal horizontal duodenum.
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