A CASE OF RIGHT PARADUODENAL HERNIA WITH MALROTATION

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  • USHIGOME Mitsunori
    Department of Surgery (Omori), Division of General and Gastroenterological Surgery, Toho University School of Medicine
  • SHIMADA Nagato
    Department of General Medicine and Emergency Care, Toho University School of Medicine
  • SAWAGUCHI Yuko
    Department of Surgery (Omori), Division of General and Gastroenterological Surgery, Toho University School of Medicine
  • HONDA Yoshiko
    Department of General Medicine and Emergency Care, Toho University School of Medicine
  • KOIKE Junichi
    Department of Surgery (Omori), Division of General and Gastroenterological Surgery, Toho University School of Medicine
  • KANEKO Hironori
    Department of Surgery (Omori), Division of General and Gastroenterological Surgery, Toho University School of Medicine

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  • 腸回転異常を伴った右傍十二指腸ヘルニアの１例

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Paraduodenal hernia is one form of internal hernias which accounts for approximately 1% of all small bowel obstructions. We present a case of a 57-year-old male who was admitted to our emergency department because of progressive abdominal pain and vomiting. He had no past modical history. Abdominal CT scan revealed a sac-like appearance of small bowel loops to the right upper guadrant of the abdomen. The CT findings were consistent with the diagnosis of strangulated ileus for right paraduodenal hernia. Contrast-enhanced CT scan showed superior mesenteric vein (SMV) rotated to the left side of SMA (SMV rotation sign). An urgent laparotomy revealed the presence of a gangreous bowel herniated through a right side paraduodenal hernia, and missing of the Treiz ligament. Accordingly right paraduodenal hernia with malrotation was diagnosed. The compromised small bowel was resected. The patient was discharged from the hospital after an uneventful recovery. Conclusion : Paraduodenal hernias are rare but can be lethal. Especially, paraduodenal hernia with malrotation is not well known. Therefore, prompt diagnosis is essential for favorable outcomes. We should be aware of possible variables of abnormal anatomies to avoid a delay in decision of surgery.

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