Right paraduodenal hernia (RPH) has been recently reported to be treated with laparoscopic surgery. We report a case of strangulated ileus that occurred as a result of RPH treated via a small umbilical incision. An 11-year-old boy presented to our hospital with complaints of sudden upper abdominal pain associated with bilious vomiting and bloody stool. We preoperatively diagnosed the case to be strangulated ileus caused by an internal hernia and thus performed emergency surgery. After the entire small intestine was carefully exteriorized via a small umbilical incision, a strangulated ileus as a result of the internal hernia was observed. A large hernia sac with its orifice on the right side of the jejunal origin was found behind the right mesocolon, on the basis of which the diagnosis of RPH was made. After releasing the strangulation, the ischemic intestine was reperfused. The hernia orifice was closed. All the abovementioned procedures were transumbilically performed. The patient's postoperative course was uneventful. An umbilical approach is useful for treating RPH because of its favorable cosmetic outcome. In addition, manual delivery of the herniated or incarcerated intestine provides a sense of safety compared with operation using forceps during laparoscopic surgery.
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