A 70-Year-Old Woman With Progressive Abdominal Pain

Ehab H. Youssef, MD, FRCR

Disclosures

August 09, 2016

The prognosis for a paraduodenal hernia is usually good with early diagnosis and surgical repair, but missed diagnosis or delayed surgical repair can lead to complications, such as the development of volvulus, mesenteric ischemia, bowel strangulation, gangrene, and potential bowel rupture and peritonitis. The treatment is usually by laparotomy with incision of the inclosing mesentery, correction of the mesenteric defect, and decompression of the bowel loops. Special attention should be devoted to avoid injury to the superior and inferior mesenteric arteries.

In this patient, after the completion of the abdominal CT scan, she experienced increasing abdominal pain with worsening distention. A decision was made to take the patient to the operating room for laparotomy. At laparotomy, a 40-cm loop of small bowel was found to have herniated through the left paraduodenal fossa. A 20-cm segment of the herniated bowel loop appeared dull and dusky. This segment was resected with a primary anastomosis and reduction of the remaining herniated bowel. The mesenteric defect was closed.

The patient recovered well in the postoperative period and, after a short stay in the surgical intensive care unit, she was transferred to the hospital floor. She continued to do well after the procedure and was discharged to home on postoperative day 5. On a 1-month follow-up visit, the incision was noted to be healing well, and the patient was generally doing well, with no abdominal pain.

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