Laparoscopic Approach to a Rare Cause of Small Bowel Obstruction: Left Paraduodenal Hernia

Document Type

Article

Publication Date

5-2026

Abstract

Introduction: Paraduodenal hernias (PDH) account for only 0.2–0.9% of intestinal obstructions; however, they are the most common congenital internal hernia. They are hypothesized to result from abnormal rotation and fixation of the midgut, creating peritoneal or mesenteric defects involving the mesocolon through which small bowel may herniate. Left-sided PDH, typically involving the fossa of Landzert, is more frequent than right-sided hernias. Patients often present with vague or intermittent abdominal symptoms, but acute presentations with obstruction and risk of ischemia occur. Computed tomography (CT) is considered the gold standard for diagnosis, although findings can mimic other obstruction causes. Because untreated PDH carries a significant risk of strangulation and mortality, timely operative management is essential. Methods and Procedures: A 28-year-old woman with a medical history of obesity, diabetes, hypertension, hyperlipidemia, and no prior abdominal surgeries presented with two days of worsening upper abdominal pain, nausea, and projectile vomiting. She was hemodynamically stable on presentation with focal epigastric tenderness without peritoneal signs. Workup included a CT abdomen and pelvis, which revealed a high-grade proximal small bowel obstruction most consistent with an internal hernia. Given the severity of obstruction and risk of strangulation, she was taken urgently to the operating room. A diagnostic laparoscopy was performed, and the patient was found to have mesenteric lymphatic congestion and viable loops of small bowel incarcerated within a left paraduodenal defect behind the descending mesocolon. Adhesiolysis was performed, and the herniated bowel was carefully reduced. The paraduodenal defect was then closed bidirectionally with 2-0 Stratafix Prolene sutures. No evidence of ischemia was observed. Results: The patient tolerated the procedure without complication. Her recovery was uneventful due to the minimally invasive nature of her procedure. She was able to be discharged on post-op day 3, tolerating a regular diet and in minimal pain. Conclusions: This case highlights the importance of maintaining high suspicion for internal hernia in patients with obstruction and no prior surgery. Prompt laparoscopic reduction and closure of a paraduodenal defect provide definitive treatment, prevent ischemia, and allow rapid postoperative recovery.

Comments

This article was published in Surgical Endoscopy, Volume 40, Issue 2 Supplement.

The published version is available at https://dx.doi.org/10.1007/s00464-026-12851-0.

Copyright © 2026.

Publication Title

Surgical Endoscopy

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