2018 Volume 43 Issue 2 Pages 190-195
Introduction: Paracecal hernia on the lateral side of the cecum is one of the least common types of internal hernia. We report herein a case of paracecal hernia on the lateral side of the cecum that was successfully diagnosed preoperatively by computed tomography (CT) and treated laparoscopically.
Case presentation: A 95-year-old man with a history of appendectomy was referred to our hospital for further evaluation. He was admitted with a diagnosis of small bowel obstruction (SBO) and was treated conservatively with placement of a long intestinal tube. Symptoms and abdominal findings immediately improved, but a large amount of fluid continued to be drained. We therefore carefully reevaluated the obstruction. CT revealed SBO caused by paracecal hernia resulting from intestinal invagination into a pouch on the lateral side of the cecum. Laparoscopic surgery was performed on hospital day 8, and we intraoperatively confirmed and repaired lateral paracecal hernia. The patient was discharged without major complications.
Conclusions: Preoperative diagnosis of internal hernia, including paracecal hernia, is relatively difficult. CT represents the most successful diagnostic modality, but requires careful examination, and laparoscopic surgery can play a useful role in definitive diagnosis and repair of SBO. Moreover, preoperative decompression facilitates safe laparoscopic surgery.
