Left Paraduodenal Hernia - A Rare Case of Chronic Abdominal Pain

A 48-year-old female, known to be diabetic and hypertensive presented with chronic intermittent abdominal pain in the left upper quadrant for 2 years. The ache was dull and colicky, which was on and off in nature. It has been worsened in the previous 2 months and sometimes associated with nausea and diarrhoea during the onset. She also reported that pain increases during food intake and sometimes it was radiating to the left lumbar region. There was no history of other associated symptoms and no history of any abdominal surgeries. Family history were unremarkable. On examination patient was alert, conscious and oriented with normal vitals. Per abdomen was soft and distended, mild tenderness over epigastrium and left hypochondrium. There was no guarding or rigidity, no mass palpable or organomegaly. Other systems were within normal limits and laboratory tests showed normal findings. Patient had taken USG abdomen initially and it was found to be normal. Later CECT abdomen taken which showed cluster of bowel loops seen in continuation with proximal jejunal loops in the region of anterior pararenal space on left side, which was suggestive of paraduodenal hernia. Small bowel barium study also done which showed cluster of jejunal loops on the left side of upper abdomen.