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Left paraduodenal hernia diagnosed preoperatively

A 43-year-old male patient admitted to emergency clinic with signs and symptoms of ileus. He had no previous abdominal surgery. Physical examination revealed nothing pathological except a mass in the left upper quadrant with minimal distention. Bowel sounds were increased. Plain abdominal radiograph showed air-fluid levels localized especially in the left upper quadrant (Fig. 1a). Computed tomography (CT) showed a sac of bowels in the left upper quadrant with air–fluid levels (Fig. 1b). Patient was operated on with tentative diagnosis of paraduodenal hernia. At laparotomy, a hernial sac of 20 cm in diameter arising from retroperitoneum displacing sigmoid mesocolon was found (Fig. 1c). Due to the midgut rotational abnormality, the last segments of duodenum were abnormally placed in the right abdomen. The intestinal loops were herniated through the created defect. The bowel loops were retrieved from the hernial sac and the defect was closed continuously by 2/0 polyglactine sutures. The patient was discharged 8 days after the surgery. Paraduodenal hernias are quite rare. They are mostly diagnosed at laparotomy. Plain abdominal radiograph and CT can demonstrate encapsulated small bowel loops with air–fluid level and the hernia sac. Palpated abdominal mass, without history of previous operation and external hernia, suspicious findings in X-ray and/or abdominal CT in symptomatic intestinal obstruction should raise the possibility of paraduodenal hernia.