A balancing act: obstruction following laparoscopic closure of a congenital paraduodenal hernia

Marisa E. Pulcrano, Lan Vu, Matthew C. Lin


Left paraduodenal hernias are congenital internal hernias caused by the failure of the mesenteric and parietal peritoneum fusion with midgut malrotation. We present a case of a 22-year-old woman who presented with acute abdominal pain and was found to have a left paraduodenal hernia on CT. She underwent a laparoscopic reduction and primary repair of the defect. She presented two weeks later with acute abdominal pain and emesis and was taken emergently to the operating room after a CT showed a high-grade obstruction at the site of the prior hernia defect. In a laparoscopic converted to open exploration, several of the prior hernia closure’s sutures were removed and the bowel was released. This case highlights the importance of a perfect hernia closure, tight enough to prevent a recurrence but not too tight to cause an obstruction.