A case of a paraduodenal hernia with a concomitant mesosigmoid defect

Introduction Intestinal obstruction by congenital internal hernia is rare and unsuspected. Case report We report the case of a 45 years-old-man diagnosed to have an intestinal obstruction caused by a double concomitant internal hernia. CT scan can provide a fast diagnosis in order not to delay the surgical intervention: the ileum had been entrapped into a big internal hernia between the transverse and the descending colon and the patient was diagnosed to have a paraduodenal hernia. During the intervention a concomitant mesosigmoid defect was found. Results Our patient had a left paraduodenal hernia with much of the small bowel crowned into a round peritoneal membrane just in front and left to the duodenum and pancreas and between the transverse and descending colon. CT scan showed encapsulated cluster of small bowel loops in the hernia sac. He was taken up for surgery and an urgent laparoscopic access was performed for definitive diagnosis and treatment 4 days after the beginning of the symptoms. Conclusions Congenital Internal Hernia should be considered as a cause of bowel obstruction in absence of previous abdominal surgery and, even if preoperative diagnosis of a paraduodenal hernia is difficult, it must be considered as part of differential diagnosis.