An Uncommon Cause of Acute Bowel Obstruction: The Left Para-Duodenal Hernia
It's about a 77 year-old woman consulting for an acute bowel obstruction evolving since two days. Physical examination showed a discrete abdominal distension and slight tenderness in the epigastric and the left upper quadrant. The digital rectal examination found anempty rectal vault. The abdominal X-ray showed an air-fluid small bowel levels. The computed tomography (CT) showed the presence of a jejunal loop contained in a retroperitoneal sac interposed between the stomach pushed forward, the tail of the pancreas to the right and back and the left colon to the left and back []. The mesenteric vessels of these loops were stretched with displacement of the inferior mesenteric artery to the left. The diagnosis of a left PH complicated with acute bowel obstruction has been well discussed. The patient was operated emergency by median laparotomy. Surgical exploration found about 40 cm of proximal healthy small bowel in an internal left paradoudenal hernia. The neck hernia was 3 cm of diameter. After reduction of intestinal loops, the hernia orifice was sutured. The postoperative course was uncomplicated. The patient remained asymptomatic after 18 months of follow-up.