Abstract
A 38-year-old man was brought to our hospital owing to lower abdominal pain. He was diagnosed as having right paraduodenal hernia with intestinal malrotation based on contrast-enhanced computed tomography findings, for which he underwent an emergency operation. The ligament of Treitz was not present, and the fusion of the right mesocolon was incomplete. The small bowel was strangulated both inside and outside the hernial sac, and most part of the small bowel was ischemic. There was a risk of short bowel syndrome if the ischemic bowel would have been resected ; therefore, we decided to close the abdomen without resecting the bowel and follow the patient's course carefully ; if intestinal necrosis was suspected during the postoperative course, the necrotic part would be resected in a second operation. The postoperative course was good, and the patient was discharged without the need for a second operation. The characteristic anatomy of a right paraduodenal hernia with intestinal malrotation causes the coexistence of normal and ischemic bowel both inside and outside the hernial sac. This feature is reflected in contrast-enhanced computed tomography findings and is useful in diagnosis.
