Midgut non-rotation with a large, dumb-bell-shaped, abscessed, air-containing right paraduodenal hernia in early childhood

A 3-year-old boy with a history of recurrent episodes of abdominal pain and vomiting, a prior history of intra-abdominal sepsis (amoebiasis), and marked retroperitoneal mesenteric lymphadenopathy on ultrasound was admitted to the hospital because of severe abdominal pain of 2 days' duration associated with fever, nausea, and vomiting. His abdomen was distended and tender and a plain X-ray film revealed a large, dumb-bell-shaped double bubble in the mid-upper abdomen. A barium enema showed non-rotation of the colon with the cecum in the left upper quadrant. At operation, a large, dumbbell-shaped right paraduodenal hernia filled with air and pus was found, but no intestine. The body of the duodenum crossed the hernia and gave it its dumb-bell shape. The hernia/abscess was opened and drained. Penrose drains were left in the abscessed area and the margin of the hernia sac that contained the superior mesenteric artery was closed around the drains with care. The postoperative course was uneventful with no recurrence of symptoms.