Minimally invasive management of a paraduodenal hernia with intestinal malrotation

Paraduodenal hernias (PDHs) are rare entities that may present with acute or subacute symptoms, and which pose challenges to prompt diagnosis and treatment. The minimally invasive management of these hernias is emerging as a new compelling approach to optimize surgical recovery. We present the case of a 42-year-old female patient who presented with acute abdominal pain and symptoms of bowel obstruction. Abdominal imaging suggested the presence of a left PDH. Laparoscopic exploration was performed. Intestinal malrotation was noted with incarceration of a small bowel loop in the Landzert fossa. The incarcerated bowel loop was freed and primary repair of the hernial defect was performed. PDHs are usually congenital and involve a herniation of abdominal content into the left mesocolon, between the mesocolon and the posterior abdominal wall. Minimally invasive treatment, consisting of adhesiolysis and repair of the hernial defect, seems to be a valid and safe option.