Abstract Left paraduodenal hernia is the most common congenital internal hernia and a rare cause of acute small-bowel obstruction. Delay in diagnosis may lead to strangulation and bowel necrosis requiring urgent surgery. We report the case of a 30-year-old man presenting to a field hospital with sudden severe abdominal pain, vomiting, tachycardia, and generalized peritonism. Abdominal computed tomography demonstrated a cluster of jejunal loops in the left upper quadrant beneath the superior mesenteric vein, consistent with left paraduodenal hernia and closed-loop obstruction. Emergency midline laparotomy revealed a necrotic jejunal segment strangulated within the hernia sac. Approximately 60 cm of jejunum was resected, and a hand-sewn end-to-end anastomosis performed. A planned second-look laparotomy 48 hours later demonstrated complete bowel viability. Despite limited diagnostic resources in the conflict-zone field hospital, early operative intervention resulted in an uncomplicated recovery. This case underscores the need for high clinical suspicion and prompt surgery when internal hernia is suspected.
Alshawwa et al. (Wed,) studied this question.