Right Paraduodenal Hernia Revealed by Strangulated Small Bowel Obstruction: A Case Report and Review of the Literature

Abstract

Internal hernias are rare causes of small bowel obstruction, accounting for less than 6% of cases. Among them, paraduodenal hernias represent the most frequent congenital subtype. Despite their rarity, they are clinically significant because they may lead to acute intestinal obstruction and bowel strangulation, associated with a high mortality rate when diagnosis is delayed. We report the case of a 75-year-old chronic smoker who presented with symptoms of acute high intestinal obstruction characterized by bilious vomiting evolving for four days and cessation of stool and flatus for two days. Physical examination revealed abdominal distension and diffuse abdominal tenderness. Abdominal computed tomography demonstrated mechanical small bowel obstruction with signs of strangulation, suggesting a possible internal hernia. Emergency laparotomy revealed a right paraduodenal internal hernia containing necrotic small bowel loops. A segmental small bowel resection of 30 cm was performed, followed by double-barrel ileostomy and peritoneal lavage with drainage. This case highlights the diagnostic challenge of internal hernias and emphasizes the importance of early surgical intervention in cases of suspected strangulated small bowel obstruction.