Munir A, Saleem S M, Hussain S.
Paraduodenal Hernia - a Case Report.
J Pak Med Assoc Jan ;54(3):162-3.

We report a case of a one-year-old boy who presented to the emergency room with 36-hour history of abdominal pain and vomiting, progressing from non-bilious to bilious and ultimately faeculent. There was also history of constipation and abdominal distension. Prior to this episode, the child was well with no co-morbid conditions. Examination revealed a listless, tachycardic and dehydrated infant with distended abdomen, which was tense and tender. The plain abdominal X-ray was consistent with intestinal obstruction. The provisional diagnosis of intussusception was made. After initial resuscitation a contrast enema was done, which showed downward displacement of transverse colon with distended small bowel loops. There was partial hold-up of contrast in mid-transverse colon. Exploratory laprotomy for mechanical bowel obstruction was planned. On exploration there was serosanginous peritoneal fluid, with stretched out collapsed transverse colon. Small bowel was seen herniating through the mesentery of transverse colon, which was stretched on it. After reduction of small bowel, the defect was identified to be in left paraduodenal space. Bowel was reduced which was congested but viable and then the defect was repaired with vicryl, taking care of the vessels at the mouth of the defect.

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