Unusual Case of Intestinal Obstruction Following Left Paraduodenal Hernia

Intestinal obstruction following Internal herniae is rare accounting for less than 4%, of which Paraduodenal hernias are the most common. A 42 yr male presented with abdomen pain & distension for two days, vomiting and obstipation for one day. Abdomen was distended with a tender mass in the left hypochondrium. X-ray showed dilated bowel loops. CT abdomen confirmed the diagnosis of small bowel obstruction. At laparotomy, impending gangrene of small bowel was visualized. A hernia sac to the left of 4 th part of the duodenum was made out, with herniation of small bowel loops & twisting of the bowel along its axis resulting in vascular occlusion. Bowel loops were retrieved, hernia sac excised & the defect was closed. Warm saline, 100% O2 were sufficient for the return of bowel viability. The patient had uneventful postoperative recovery. Para-duodenal herniae are relatively rare. A timely & correct diagnosis is essential to prevent mortality and morbidity.