A balancing act: obstruction following laparoscopic closure of a congenital paraduodenal hernia

Left paraduodenal hernias are congenital internal hernias caused by the failure of the mesenteric and parietal peritoneum fusion with midgut malrotation. We present a case of a 22-year-old woman who presented with acute abdominal pain and was found to have a left paraduodenal hernia on CT. She underwent a laparoscopic reduction and primary repair of the defect. She presented two weeks later with acute abdominal pain and emesis and was taken emergently to the operating room after a CT showed a high-grade obstruction at the site of the prior hernia defect. In a laparoscopic converted to open exploration, several of the prior hernia closure’s sutures were removed and the bowel was released. This case highlights the importance of a perfect hernia closure, tight enough to prevent a recurrence but not too tight to cause an obstruction.