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Right paraduodenal internal hernia with small bowel obstruction

Case contributed by Gaurav Som Prakash Gupta
Diagnosis certain

Presentation

Acute pain abdomen. Mild guarding and mild vomiting and pain abdomen. Total leukocyte count mildly increased.

Patient Data

Age: 25 years
Gender: Male

The small bowel loops appear to be herniating in a posterior and right lateral direction resulting in alteration of the course of the SMA. The hernial sac is displacing the SMA, which is seen lying anterior to the hernia sac. The artery is then looping and turning posteriorly and subsequently supplying the herniated bowel loops by branches that are now running posteriorly and towards the right.  Dilated small bowel loops (up to 3.8 cm in diameter).

Although the lateral portion of the third part of the duodenum is not seen, however, no other definite signs of bowel non-rotation noted. The relation of the SMA and the SMV appears to be maintained. The hernial sac is also showing significant amount of fluid. 

A significant amount of fluid noted in the hernial sac. However, the wall of the herniated loops appears to be enhancing at present. Fluid is also seen in pericaecal and retrocolic region along ascending colon. Appendix not clearly defined. ICJ is normal. Terminal ileum is stretched but normal. 

Case Discussion

Features are consistent with a right paraduodenal internal hernia with small bowel obstruction. These findings were confirmed surgically.

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