A Case of Strangulated Bowel Obstruction Caused by Meckel’s Diverticulum, Intestinal Malrotation, and Right Paraduodenal Hernia

Abstract

A 5-year-old boy with a history of repair of a low-type anorectal malformation was transferred to our institution for suspected bowel obstruction after presenting with abdominal pain and vomiting. On arrival, he exhibited abdominal distension and tenderness. Contrast-enhanced CT revealed clustered small bowel loops in the right upper quadrant with distal dilatation. These findings were suggestive of strangulated bowel obstruction caused by a right paraduodenal hernia (PDH), and emergency laparotomy was performed. Intraoperatively, the small intestine was found to be incarcerated through a hernia orifice formed by incomplete fusion between the right colonic mesentery and the retroperitoneum. After enlargement of the orifice, ileal torsion around Meckel’s diverticulum was identified. Detorsion and partial ileal resection, including the diverticulum, were performed. The jejunum was located on the right without the formation of the ligament of Treitz, indicating malrotation. In right-sided PDH, the hernia sac is often opened to prevent recurrence. However, in cases complicated by intestinal malrotation, the superior mesenteric artery and ileocolic artery may run close to the hernia orifice; therefore, careful assessment of the mesenteric vasculature is essential to avoid vascular injury during surgical manipulation. This case is notable for the preoperative suspicion of right PDH based on contrast-enhanced CT findings and by the rare mechanism of a strangulated bowel obstruction caused by ileal torsion around Meckel’s diverticulum within the hernia sac. These findings highlight the importance of accurate imaging diagnosis and an appropriate surgical strategy in the management of right-sided PDH.