Left paraduodenal hernia: a rare cause of gastric outlet obstruction and large bowel obstruction

Paraduodenal hernia is a rare subset of internal hernia and an uncommon aetiology of bowel obstruction. A 50-year-old male presented with a 12 h history of severe epigastric pain and vomiting. A contrast enhanced computed tomography scan of the abdomen and pelvis demonstrated gastric outlet obstruction and large bowel obstruction due to left paraduodenal hernia involving the distal transverse colon and gastric antrum. After resuscitation, a laparotomy was performed, the bowel was reduced, the mesocolic defect repaired, and small bowel mesentery widened. The large bowel was decompressed via the appendix stump. The post-operative recovery was unremarkable. Left paraduodenal hernia is a rare condition and where seen acutely, usually presents with small bowel obstruction. Here the patient presented with a large bowel obstruction, a rare presentation of this uncommon condition. Operative intervention is mandatory in the acute setting to prevent ischaemia and perforation from strangulation of the bowel.