Left Paraduodenal Hernia Presenting as Acute Small Bowel Obstruction: A Case Report

Abstract

Background: Left paraduodenal hernia (LPDH) is the most common congenital internal hernia but remains a rare cause of acute small bowel obstruction. It occurs through Landzert's fossa as a consequence of abnormal embryological rotation and fixation of the midgut. Clinical manifestations range from recurrent nonspecific abdominal pain to acute obstruction, strangulation, and bowel ischaemia. Contrast-enhanced CT is particularly useful for recognising clustered jejunal loops in the left upper abdomen, mesenteric vessel crowding, and the characteristic anatomical relationship of the herniated bowel with the stomach, pancreas, and ligament of Treitz. Early surgical intervention is essential when obstruction or strangulation occurs to prevent irreversible bowel ischaemia. This case highlights the presentation, radiological diagnosis, operative management, and successful bowel preservation in a 32-year-old man with acute small bowel obstruction caused by LPDH. Case Presentation: A 32-year-old man with no history of previous abdominal surgery presented with acute colicky upper abdominal pain, recurrent bilious vomiting, abdominal distension, and inability to pass flatus. Physical examination revealed mild epigastric tenderness without signs of generalised peritonitis. Laboratory investigations were unremarkable. Contrast-enhanced computed tomography demonstrated clustering of jejunal loops in the left upper abdomen, displacement of adjacent mesenteric vessels, and features suggestive of a left paraduodenal hernia causing small bowel obstruction. Emergency exploratory laparotomy confirmed herniation of proximal jejunal loops through Landzert's fossa. The viable bowel was reduced, the hernia sac was opened, and the defect was closed with interrupted Prolene 2.0 rounded-body, non-absorbable sutures placed in an avascular plane to prevent adjacent bowel ischaemia and recurrence. The postoperative recovery was uneventful, and the patient was discharged on the fifth postoperative day. At follow-up, he remained asymptomatic without recurrence. Conclusion: Left paraduodenal hernia is a rare but important differential diagnosis in young adults presenting with intestinal obstruction without previous abdominal surgery. Characteristic computed tomography findings facilitate early diagnosis, while prompt surgical intervention prevents bowel ischaemia and recurrence. Increased awareness among clinicians and radiologists can improve timely diagnosis and reduce morbidity associated with this uncommon congenital internal hernia.