2019 Volume 39 Issue 1 Pages 063-067
An 87-year-old woman visited our hospital complaining of abdominal pain. On physical examination, the lower abdomen was distended and there was tenderness in the same region. Abdominal CT revealed massive ascites and a poor contrast effect of a wide range of the intestine. Suspecting an intestinal hernia with strangulated obstruction of the small intestine, we performed emergency surgery. We could find no obvious malrotation, but a hernial orifice, 5 cm in size, corresponding to the inferior duodenal fossa of Treitz, was noted. The intestine passed via the hernial orifice from the free abdominal cavity into the hernial sac, which was on the dorsal aspect of the mesentery of the colon on the right side; it ran into the hernia sac then passed the hernia gateorifice? again in the opposite direction. The small intestine caught in the hernia sac was strangulated at the hernia orifice and a 200-cm segment was found to be ischemic. Therefore, we resected the necrotic segment of the small intestine. We made the diagnosis of a right paraduodenal hernia with strangulated obstruction of the small intestine. In many cases of this disease, emergency operation is needed because of symptomatic intestinal obstruction. Because strangulated obstruction of the small intestine sometimes develops, it is considered necessary to perform surgical treatment at the time of diagnosis.
