A Case of Barium Appendicitis with Mesenterium Commune and Left Paraduodenal Hernia

Abstract

Appendicitis in cases with an abnormal position of the appendix and barium appendicitis are difficult to diagnose. A 48-year-old man was brought to our hospital by ambulance for lower abdominal pain developing a day after he underwent an upper gastrointestinal barium study. Computed tomography showed a right-sided sigmoid colon, with the ascending colon shifted towards the midline of the abdomen, and extraintestinal gas. The patient was initially diagnosed as having gastrointestinal perforation due to intestinal malrotation, and emergency laparotomy was performed. Intraoperative examination revealed a perforated appendix. The ascending colon, ileocecum, and the entire small intestine had herniated through the hernia orifice located behind the inferior mesenteric vein. Finally, the patient was diagnosed as having barium appendicitis, mesenterium commune, and left paraduodenal hernia. Left paraduodenal hernia with mesenterium commune is rare, and preoperative diagnosis is extremely difficult due to artifacts created by barium. The positional relation between the inferior mesenteric vein and gastrointestinal tract may help in the diagnosis of left paraduodenal hernia with mesenterium commune. Computed tomography with coronal imaging may be useful for the diagnosis of barium appendicitis.