A Rare Case of Complex Left Paraduodenal Hernia with Cocoon Abdomen

Paraduodenal hernias are rare congenital hernias that account for approximately 0.2-0.9% of all internal hernias. Among them, left paraduodenal hernias are even rarer, with an incidence of about 0.8%. Cocoon abdomen, also known as sclerosing encapsulating peritonitis, is a rare condition characterized by the encapsulation of the small bowel by a thick fibrous membrane, leading to intestinal obstruction. We present a rare case of a 45-year-old female patient who presented with complaints of left upper abdominal pain, intermittent vomiting, and abdominal distension for two months. Imaging studies revealed a complex left paraduodenal hernia with cocoon abdomen, leading to subacute intestinal obstruction. The patient underwent exploratory laparotomy, reduction of small bowel contents from the hernial sac, excision of the hernial sac, extensive adhesiolysis, and closure of the hernial defect. Intraoperatively, the entire small bowel from the duodenojejunal flexure to the ileocecal junction was encased in a thick peritoneal sac, with dense interbowel adhesions and a thick hernial sac. The postoperative course was complicated by paralytic ileus, which was managed conservatively. The patient recovered well and was discharged on a low-residue diet and appropriate medications. This case highlights the rare coexistence of a left paraduodenal hernia and cocoon abdomen, emphasizing the importance of early diagnosis and timely surgical intervention to prevent potential life-threatening complications