Paraduodenal hernias in children: Etiology, treatment, and outcomes of a rare but real cause of bowel obstruction

Highlights • Paraduodenal Hernia has rarely been reported in the pediatric age group. • Paraduodenal Hernia is a rare cause of intestinal obstruction and is often misdiagnosed. • CT-scan is the gold standard mean for diagnosis in most cases. • Paraduodenal Hernia must be kept in mind as a possible cause of intestinal obstruction.
Introduction Paraduodenal Hernia (PDH) is the most common variant of internal hernia and occurs most often in males during their 4th–6th decades of life. PDH in pediatric age group has rarely been reported in literature with only five cases of age up to 10 years were reported. PDH is a rare cause of intestinal obstruction, which may lead to subsequent strangulation and perforation of the bowel. Presentation of case We reported a 1.5 year-old male child presented with intestinal obstruction. The patient experienced abdominal pain, vomiting and irritability. Abdominal x-ray showed distal intestinal obstruction which was discovered to be a result of left PDH incidentally during the surgery. In addition, we performed a literature search using PubMed to identify the published cases of PDH. We also compared our case with the characteristics of all reported PDHs in toddlers and children up to 10 years of age in a concise table. Discussion Despite its congenital origin, PDH has been reported in childhood age group in very rare occasions rendering the accurate incidence of PDH in infancy and childhood unknown. PDHs can be asymptomatic or can present most commonly with recurrent upper abdominal pain. Diagnosis is quite difficult in the absence of symptoms but could be achieved using a computed tomography (CT-scan) in non-emergency symptomatic patients. Surgical repair is mandatory to avoid potential complications. Conclusion As PDH can lead to major and life threatening complications, it must remain in our minds as a possible cause of intestinal obstruction.