Laparoscopic Management of a Symptomatic Paraduodenal Hernia Complicated by Ureteric Compression: A Case Report.

Paraduodenal hernias (PDHs) are a rare variant of congenital internal hernias that result from abnormal midgut rotation and represent the commonest type of internal hernia. They often result in intermittent or acute small bowel obstruction (SBO), but can present with rare complications. A 41-year-old male patient presented with episodic abdominal pain for eight months. There were no other associated symptoms. Imaging for suspected ureteric colic was done, and it was revealed that there were encapsulated small bowel loops in the left upper quadrant (LUQ). CT abdomen was consistent with a left PDH, with associated left hydronephrosis likely due to ureteric compression by the hernial sac, and incidental right renal calculi. Laparoscopic exploration confirmed a paraduodenal recess containing trapped jejunal loops. During the surgery, the inferior mesenteric vein (IMV) was divided to facilitate reduction, and the defect was closed. Postoperative recovery was uneventful, with complete resolution of symptoms. After two days, the patient was discharged and scheduled for a clinic review. PDH is an important, rare cause for chronic, episodic, unexplained abdominal pain. It also demonstrates that rare urinary tract complications can occur, and that laparoscopic repair with defect closure is an effective and safe management strategy.