Unmasking right paraduodenal hernia: a rare cause of small bowel obstruction

Right paraduodenal hernia (PDH) is one of the congenital internal hernias resulting from developmental error of midgut rotation and is a rare cause of small bowel obstruction. Because of its nonspecific clinical presentation and low index of suspicion, preoperative diagnosis is challenging. We report a case of a 40-year-old male who presented with features of intestinal obstruction. Computed tomography of the abdomen revealed clustered small bowel loops in the right upper quadrant with characteristic displacement of mesenteric vessels, suggestive of a right PDH. Emergency laparotomy confirmed herniation of jejunal and ileal loops through the fossa of Waldeyer with evidence of bowel gangrene. The surgical management followed in our patient is reduction of the herniated bowel, resection of nonviable bowel segments, temporary ostomy, and definitive closure of the hernia defect. The postoperative course was uneventful and the patient recovered well.