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Laboratorio de Desarrollo-Envejecimiento, Enfermedades Neurodegenerativas, Centro de Investigacion Biomedica de Occidente, Instituto Mexicano del Seguro Social. Sierra Mojada 800, 44243, Guadalajara, Jalisco, Mexico. 2 Centro Universitario de Ciencias de la Salud (CUCS), University of Guadalajara, Guadalajara, Jalisco, Mexico. Asociacion Mexicana de Atrofia Muscular Espinal (AMAME), Guadalajara Jalisco, Mexico. 4 Department of Internal Medicine, University of Iowa Hospital and Clinics, Iowa, USA. Centro Universitario de Ciencias Exactas e Ingenierias, University of Guadalajara, Guadalajara, Jalisco, Mexico.

INTRODUCTIONParagangliomas are neuroendocrine tumors of the autonomic nervous system that arise from neural crest cells. Paragangliomas are typically extra-adrenal, non-functional and can be discovered incidentally, posing diagnostic and therapeutic challenges.PRESENTATION OF CASEWe present the unusual case of a young man who presented with an acute abdomen secondary to small bowel obstruction, and was found to have an incidental left-sided subdiaphragmatic paraganglioma supplied by a branch of the contralateral right renal artery.DISCUSSIONEmergent laparotomy revealed an internal hernia as the source of the small bowel obstruction. Initial attempts to remove an incidental left subdiaphragmatic mass were aborted because of bleeding. Subsequently, after preoperative superselective embolization of the feeding vessel arising from the right renal artery, the mass was successfully resected. Pathology was consistent with a paraganglioma.CONCLUSIONThis report highlights the rarity of the location and blood supply of an incidental left subdiaphragmatic paraganglioma found in the setting of a small bowel obstruction.