Abstract
A 74-year-old man who was seen at our hospital because of abdominal pain was found having a dilated small intestine at the dorsal aspect of the cecum by an abdominal CT scan, and was admitted with a diagnosis of paracecal hernia. After admission placement of a long tube provided symptomatic remission, so that elective surgery was planned on the second hospital day. In the early morning of the operating day, he developed a high fever of 38.5°C. When he entered the operating room, the level of consciousness was III-100, the blood pressure was 68/40 mmHg, and the pulse was 112, showing a shock state. Immediately after introduction of anesthesia, the blood pressure became untouchable. Then we started the operation while we were doing heart massage. Laparotomy disclosed a small intestine about 50 cm apart from the ileum end to have incarcerated in a concave which was posterior to the cecum. Maneuver reduction of the incarcerated intestine was done when the color of the intestine was kept intact. No bowel resection was thus performed. The concave at the retroperitoneum was closed by sutures.
Although paracecal hernia is a relatively rare entity, it reveals characteristic CT findings and so preoperative diagnosis can be made. The disease resists against conservative therapy, and the patient has to be operated on as soon as possible after it is diagnosed.
