Intestinal Obstruction due to an Internal Hernia in the Paracolic Gutter of the Descending Colon—A Case Report—

Abstract

An internal hernia in the paracolic gutter of the descending colon is exceedingly rare. A case of intestinal obstruction due to this type of internal hernia is reported. A 54-year-old woman was admitted with abdominal pain. Computed tomography (CT) showed tapering and obstruction of the intestine on the left side of the abdominal cavity, leading to a diagnosis of intestinal obstruction. A long tube was inserted as conservative therapy, but the abdominal pain worsened on the 3rd day of admission, necessitating emergent laparoscopic surgery. Since part of the small intestine was invaginated into the retroperitoneal space through a defect in the paracolic gutter of the descending colon, intestinal obstruction due to an internal hernia was diagnosed. The invaginated intestine was reduced, and the hernial hilus was opened laparoscopically. The patient was discharged on postoperative day 7. Retrospectively reviewing the CT on admission showed a loop of small intestine posterior to the descending colon, which is a characteristic CT finding of an internal hernia in the paracolic gutter of the descending colon.