A Case of Paracecal Hernia Diagnosed Early and Treated with Emergency Laparoscopic Surgery

Abstract

An 86–year–old woman who had a history of appendectomy during childhood was admitted to the hospital because of the sudden onset of a right lower abdominal pain after dinner. Abdominal contrast–enhanced computed tomography (CT) showed a dilated small intestine with a closed–loop situated posterolateral to the cecum and a dilated oral intestinal tract. She was diagnosed as having strangulation of the ileum because of the incarceration of a paracecal hernia, and emergency laparoscopic surgery was performed approximately 5 hours after onset. Upon exploration of the abdominal cavity, a loop of ileum was found incarcerated in a 2cm orifice located on the lateral side of the cecum. After reducing the incarceration, the incarcerated ileum was approximately 10 cm in length and the tissue remained viable. The hernia orifice was incised and widened to prevent re–incarceration. The patient’s postoperative course was uneventful, and she was discharged on the 12th hospital day without any complications. Although paracecal hernia is a relatively rare entity, preoperative diagnosis is not difficult because of characteristic CT findings. Laparoscopic surgery may be useful for the diagnosis and treatment of paracecal hernia.