Left Paraduodenal Hernia: A Challenging Diagnosis in Intestinal Obstruction

Internal hernias are a rare cause of intestinal obstruction, accounting for a small proportion of cases. Among these, paraduodenal hernias represent a significant subtype and require prompt recognition and intervention to prevent life-threatening complications. We report the case of a 31-year-old male with no significant medical or surgical history who presented with a three-day history of generalized abdominal pain, vomiting, and constipation. Clinical examination revealed abdominal distension, tenderness, and hyperactive bowel sounds. Laboratory findings were unremarkable except for leukocytosis. Abdominal X-ray demonstrated features of small bowel obstruction, and CT imaging identified findings suggestive of a left paraduodenal hernia. Exploratory laparotomy revealed a large encapsulated peritoneal sac originating from the left paraduodenal region and extending into the pelvis. Dilated and edematous but viable small bowel loops were released, and adhesiolysis was performed. A planned second-look surgery two days later confirmed resolution of bowel edema, and the abdomen was closed without complications. Paraduodenal hernias arise from a congenital anomaly involving the mesentery and often present as intermittent or acute bowel obstruction. Diagnosis is challenging due to nonspecific symptoms but can be facilitated by CT imaging. Definitive management involves surgical reduction and repair of the hernia, whether through open or laparoscopic approaches. This case highlights the importance of considering internal hernias in young patients with small bowel obstruction and no prior abdominal surgery. Prompt imaging, timely surgery, and individualized management are crucial for optimal outcomes.