A Case of Lateral Paracecal Hernia that was Difficult to Differentiate from Adhesive Small Bowel Obstruction

Abstract

An 85-year-old woman with a history of open appendectomy presented with a 10-hour history of vague abdominal pain. Physical examination revealed abdominal tenderness and a scar in the right lower abdomen. Abdominal contrast-enhanced computed tomography showed a caliber change of the ileum in the same region. She was diagnosed as having adhesive small bowel obstruction and a transnasal ileus tube was inserted for decompression of the bowel. On day 2 after the insertion, a small-bowel contrast study through the ileus tube showed severe stenosis of the diseased ileum. An emergent laparoscopic surgery was performed, which revealed the incarcerated 20-cm-long segment of the ileum on the lateral-dorsal aspect of the cecum. The necrotic small bowel was resected. The patient was discharged on day 7 after surgery. We report the case of lateral paracecal hernia causing small bowel obstruction.