Strangulated Small Bowel Obstruction Caused by Paracecal Hernia

Abstract

Adhesion is the most common cause of small bowel obstruction, accounting for about 60％ of all cases. However, among patients with strangulated small bowel obstruction and a history of laparotomy, there are cases in which small bowel obstruction is not caused by adhesion, but by paracecal hernia. Here, we describe a case of strangulated small bowel obstruction caused by a paracecal hernia. A 73–year–old woman who underwent total hysterectomy presented with abdominal pain and vomiting and was diagnosed as having strangulated small bowel obstruction based on the findings of abdominal CT. Initially, adhesion was suspected as the cause of the intestinal obstruction. However, intraoperative findings revealed a lateral type of paracecal hernia with small bowel obstruction. Postoperative review of CT revealed displacement of the cecum and ascending colon into the ventral and medial sides because of a closed small intestinal loop that was present behind the colon. Furthermore, our case report suggests that in cases that exhibit the abovementioned CT findings, despite a history of laparotomy, paracecal hernia rather than adhesion should be considered as the likely cause of strangulated small bowel obstruction.