Internal Hernia: A Rare Cause of Bowel Ischemia and Infarction

Internal abdominal hernias are uncommon causes of intestinal obstruction and are difficult to detect preoperatively due to their imprecise clinical manifestations and complicated anatomic appearance. Paraduodenal hernias represent the most common subset of all internal hernias (IHs). The symptoms are nonspecific and range from persistent abdominal discomfort to acute abdomen. An expert radiologist and a high index of suspicion of IH are required to diagnose timely and to prevent its fatal complications, such as bowel ischemia and infarction. An IH is a potentially fatal entity if misdiagnosed and not treated timely. We present a case of a 16-year-old boy managed with an exploratory laparotomy for a strangulated internal (left paraduodenal) hernia in an emergency. A total of 274 cm of small bowel was resected, and only 140 cm of jejunum was left behind. A jejunostomy was created. This case report reveals the importance of timely management and fatal complications due to delayed diagnosis and treatment of IHs.