# Strangulated left paraduodenal hernia with jejunal necrosis managed in a field hospital: a case report

## TL;DR

A 30-year-old man with a rare left paraduodenal hernia causing bowel necrosis was successfully treated with emergency surgery in a field hospital.

## Contribution

This case highlights the management of a rare hernia in a conflict zone with limited resources.

## Key findings

- CT imaging confirmed a left paraduodenal hernia with closed-loop jejunal obstruction.
- Emergency surgery resected 60 cm of necrotic jejunum and restored bowel continuity.
- A second-look laparotomy confirmed successful recovery with no complications.

## 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.