Paraduodenal hernia with associated intestinal malrotation and Meckel's diverticulum

<p>A 33-year-old man was urgently transported to our hospital because he was experiencing acute abdominal pain and vomiting. A contrast-enhanced abdominal CT scan revealed intestinal obstruction and a sac-like appearance of the intestines. The small intestine within the internal hernia showed poor enhancement. The patient was diagnosed with strangulated intestinal obstruction due to a paraduodenal hernia, and emergency surgery was performed. Intraoperatively, we found that almost the entirety of the small intestine had protruded into the hernia sac, and some areas already showed ischemic changes. After the hernia sac was opened, blood flow to the ischemic intestine was immediately restored. On further evaluation of the hernia, we found that the horizontal duodenum was absent, and the cecum until the ascending colon were not fixed to the retroperitoneum. A Meckel's diverticulum, sized 4 cm, was found 60 cm from the end of the ileum. We intraoperatively diagnosed strangulated intestinal obstruction due to a right paraduodenal hernia with associated intestinal malrotation and an asymptomatic Meckel's diverticulum. Thereafter, we resected the Meckel's diverticulum, and performed an appendectomy. Some cases of intestinal malrotation may be associated with other congenital gastrointestinal anomalies ; however, it is difficult to detect these anomalies using preoperative imaging. Therefore, the presence of coexisting congenital anomalies, such as intestinal malformations, should be considered, preoperatively and intraoperatively, in young patients who present with intestinal obstruction without a previous laparotomy.</p>