TOTAL BOWEL OBSTRUCTION WITH RIGHT PARADUODENAL HERNIA: A RARE CASE REPORT

Abstract

Introduction: Para duodenal hernia is an internal hernia type which categorized as a rare congenital anomaly due to defect in reduction and rotation of the midgut which can cause 1% of all obstruction cause. The interruption of blood flow in an intestinal segment beside the lumen obstruction characterizes the strangulation obstruction. The clinical symptoms are non-specific and it depends on the degree of obstruction.  Clinical presentation of pain, vomiting, distension and constipation, laboratory, and radiographic factors should all be considered when deciding on the treatment of bowel obstruction.

Case presentation: A 79 years old man came to the hospital with chief complaints of difficulty to defecation for 1 week. Physical examination reveals that the patient has a distended abdomen with bowel sound still positive and icteric. Laboratory findings reveal an increase of bilirubin total and direct (17.78 mg/dL and 17.70 mg/dL, respectively) and mild hyponatremia (132 mmol/L). The patient was diagnosed with total hernia obstruction with a paraduodenal hernia. The patient undergoes laparotomy and durante operation, hemicolectomy dextra, and double barrel ileo-transversostomy were performed.

Conclusion: We found that this patient at Saiful Anwar General Hospital has paraduodenal hernia as the cause of total bowel obstruction. We perform resection of non-viable ileum and appendix + double-barrel ileo-transversotomy and excision of a hernial sac. The postoperative outcome in this patient is uneventful.