Left paraduodenal hernia causing small bowel obstruction in an adolescent patient

Internal hernias are an uncommon cause of bowel obstruction, accounting for less than 1% of cases. Paraduodenal hernias, the most common type of internal hernias, are believed to be congenital in origin. They can be asymptomatic, cause chronic abdominal pain, or present with acute intestinal obstruction with strangulation and ischemia. We describe a case of left paraduodenal hernia found in a patient who presented with acute intestinal obstruction.     

Laparoscopic treatment of left paraduodenal hernia in two cases of children

IntroductionThe paraduodenal hernia is an internal hernia that might cause a small bowel obstruction. The laparoscopic repair of paraduodenal hernia is sporadically reported for its safety, convenience, and patient's satisfaction.Presentation of caseWe performed the laparoscopic treatment of the left paraduodenal hernia in two children, a 3-months old boy and 12-year old girl. The girl had a left upper quadrant pain for one month with postprandial nausea after eating. The 3-months boy presented with an intermittent severe irritability. Small bowel series and computed tomography showed the left paraduodenal hernia in two patients. We successfully did the laparoscopic paraduodenal hernia repair using 5 mm and 3 mm laparoscope. They discharged within 5 days, uneventfully.DiscussionDespite of technical difficulties in pediatrics such as small working space and less pneumoperitoneum, the laparoscopic repair for paraduodenal hernia leads to patient's earlier intake of diet and rapid recovery with cosmetic satisfaction. The 3 mm laparoscopic repair needs longer operation time, but it is feasible in infants.ConclusionLaparoscopic repair of paraduodenal hernia in children and infants is safe and feasible. We recommend the laparoscopic repair as the first surgical option for paraduodenal hernia.     

Laparoscopic repair of a right paraduodenal hernia

Background: Laparoscopic repair of a right paraduodenal hernia has never been described in the literature. A 24-year-old woman was admitted after 2 weeks of intermittent abdominal pain associated with nausea and vomiting. Physical examination was normal. Laboratory studies and upper endoscopy were normal. Computed tomography revealed that the small bowel was on the right side of the abdomen and the colon on the left, suspicious for malrotation. Subsequent upper gastrointestinal series with small bowel follow-through revealed the ligament of Treitz on the right with the small bowel encased within a probable hernia sac. A presumptive diagnosis of a right paraduodenal hernia was made.Methods and Results: Initial access was obtained with a 10-mm infraumbilical port followed by placement of 5-mm ports in the right and left upper and lower quadrants. The duodenum was identified and the small bowel was found encased within a hernia sac, which was opened widely from the duodenum to the pelvis. The hernia sac was opened laterally to avoid injury to the superior mesenteric vessels. The small bowel was then released from the sac into the peritoneal cavity. The entire bowel was inspected and no other abnormalities were noted. The patient had resolution of her abdominal pain and her postoperative course was uncomplicated. She was discharged home on postoperative day 3 and has since done exceptionally well.Conclusions: Paraduodenal hernia, a rare cause of small bowel obstruction, can present a diagnostic challenge. However, when the diagnosis is made preoperatively, a laparoscopic repair is a feasible and practical option. Poster presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Los Angeles, CA, USA, 12–15 March 2003 This article contains the opinions of the authors only and does not represent the opinions of the U. S. Department of Defense or the U. S. Army.     

An unusual variant of a left paraduodenal hernia diagnosed and treated by laparoscopic surgery: Report of a case

An 80-year-old woman who had undergone both a cholecystectomy and an appendectomy presented with intermittent abdominal pain. Computed tomography (CT) revealed an encapsulated circumscribed cluster of jejunal loops in the left upper quadrant. The hernia orifice was adjacent to the left side of the superior mesenteric artery and vein. An upper gastrointestinal series also revealed a cluster of jejunal loops, suggesting the possibility of an internal hernia. Laparoscopic surgery was performed. The hernia orifice was found to be caused by abnormal adhesion between the transverse mesocolon and the jejunum mesentery. An adhesiotomy reduced the jejunum entrapped in the hernia. The hernia space was a large mesocolic fossa composed of transverse mesocolon and mesentery, continuing to the splenic flexure. The hernia was classified as a variant of paraduodenal hernia.     

A case of a paraduodenal hernia

Paraduodenal hernias are rare hernias that result from error of rotation of the mid-gut. It can be discovered incidentally at laparotomy, seen on radiological imagining or infrequently cause intestinal obstruction. We report a case of a left paraduodenal hernia diagnosed intraoperatively after being operated on in the emergency setting for generalized peritonitis. He required resection of multiple loops of small bowel with primary anastomosis. The mouth of the sac was obliterated by suture apposition to the posterior wall. The patient was discharged on day 4 after an uneventful recovery.     

Volvulus of the small intestine caused by right paraduodenal hernia: a case report

This report describes a very rare case of right paraduodenal hernia presenting as volvulus of nonherniated small intestine. A 12-year-old boy presented with sudden onset of lower abdominal pain, and emergency laparotomy was performed on a diagnosis of small intestinal obstruction. Laparotomy confirmed right paraduodenal hernia and volvulus of the small intestine out of the hernia sac.     

Laparoscopic repair of a paraduodenal hernia

Paraduodenal hernias have traditionally been treated by conventional laparotomy. We report the first case of a left paraduodenal hernia treated laparoscopically. A 44-year-old man was admitted with abdominal pain and nausea. Computed tomography and an upper gastrointestinal series with small-bowel followthrough showed accumulation of the small bowel on the left side of the abdomen. A laparoscopic repair was performed. The small bowel was observed beneath a thin hernia capsule. Approximately 1.5 m of jejunum was easily reduced into the abdominal cavity. The hernia orifice (5-cm diameter) was closed intracorporeally with five interrupted sutures. Good exposure of the operative field is critical to this procedure; poor exposure may limit the applicability of the laparoscopic approach. This minimally invasive operation is currently indicated in nonobstructive paraduodenal hernias, especially on the left. Received: 7 October 1996/Accepted: 11 April 1997     

16例十二指肠旁疝的诊断与治疗

目的总结十二指肠旁疝（ PDH）的诊治经验.方法回顾分析 1962- 2003年间经外科手术治疗的 16例 PDH患者的临床资料.结果本组患者平均年龄 36岁.左侧 PDH（ Landzert隐窝） 13例,右侧 PDH（ Waldeyer隐窝） 3例. 10例患者平时无任何临床症状;3例患者在饱食后、 13例患者在剧烈运动或突然改变体位后出现上腹剧烈疼痛.腹部 X线检查提示 12例为完全或不完全性肠梗阻. B型超声及 CT显示, 6例左上腹胰腺和胃之间有扩张的囊性空肠袢.术前误诊率 87.5%. 16例均行手术治疗,术后 10- 13 d痊愈.经 2- 4年随访,均无疝复发.结论 PDH误诊率高,积极手术探查是正确诊断和治疗成功的关键.     

Computed tomography diagnosis of symptomatic right paraduodenal hernia associated with enteric duplication cyst

Paraduodenal hernias rarely present with symptoms in children. We report a case of a right paraduodenal hernia associated with enteric duplication cyst that caused intestinal suboclussion in a 9-month-old female infant. Paraduodenal hernia was detected by contrast-enhanced computed tomography. In a review of the English-published literature, we have not found other reports of the association of paraduodenal hernia and enteric duplication cyst. A high index of suspicion is required for detecting paraduodenal hernias in children, and abdominal computed tomography is the most specific imaging study for their preoperative diagnosis.     

Paraduodenal herniation: An internal herniation in a virgin abdomen

INTRODUCTION

A paraduodenal hernia is an uncommon hernia that results from an abnormal rotation of the midgut. Commonly, these hernias are congenital in nature, and are reported to cause 1.5–5.8% of intestinal obstructions. These hernias occur when a part of the jejunum herniates through the posterior portion of the ligament of Treitz. Diagnosing these hernias preoperatively has been shown to be difficult, despite the studies that are available. Early diagnosis is imperative to the patient in order to avoid strangulation of the bowel, which is associated with a high mortality.

PRESENTATION OF CASE

In this case, we present a case of a left-sided paraduodenal hernia in a virgin abdomen in a 38-year-old African American male with a herniation of a loop of jejunum through a defect of the posterior portion of the ligament of Treitz. The patient also had a volvulized segment of the proximal jejunum, and part of this bowel was found to be ischemic.

DISCUSSION

Acute intestinal obstruction caused by a left paraduodenal hernia is a rare cause of intestinal obstruction. A literary search of PubMed between 1980 and 2012 indicated only 44 cases of intestinal obstruction secondary to a left paraduodenal hernia.

CONCLUSION

The patient underwent exploratory laparotomy, and the herniated bowel was found to be ischemic. The hernia was reduced, and the ischemic bowel resected. The defect was closed, and the patient had a non-complicated recovery.     

Small intestinal strangulation due to a primary internal paracecal hernia

The discovery of a paracolic hernia is an unusual event, even for an experienced specialist in colorectal surgery. We report a case of a 59-year-old woman with no previous history of abdominal surgery, who presented to the Emergency Department complaining of episodic abdominal pain and distension accompanied by a palpable mass in the right lower quadrant. At laparotomy, a paracecal hernia with small bowel volvulation was found. The prime objective of this report is to draw the clinician's attention to the necessity of making a rapid diagnosis of internal hernias.     

Treitz’s hernia

Treitz’s hernia is the eponymous name for a paraduodenal hernia. These are rare hernias that arise in the potential spaces and folds of the posterior parietal peritoneum adjacent to the ligament of Treitz. Presentation may be acute with small bowel obstruction or bowel ischaemia, or with chronic intermittent abdominal pain. Treatment is by surgery, due to the high (50%) lifetime risk of obstruction. Here, we present two cases from our own institution and review the literature regarding the embryology, anatomy, cross-sectional imaging and surgery of these fascinating hernias.     

A massive left paraduodenal fossa hernia as an unusual cause of small bowel obstruction

We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia, containing over 30% of the small bowel, presenting with a history of recurrent incomplete small bowel obstruction.     

Laparoscopic repair of a right paraduodenal hernia in a child.

Paraduodenal hernias are infrequently occurring rotational anomalies. We report a case of a right paraduodenal hernia repaired via laparoscopy, which occurred in a 13-year-old boy.     

Rare small bowel obstruction: Right paraduodenal hernia. Case report

INTRODUCTIONParaduodenal hernia (paramesocolic hernia), a rare congenital anomaly due to a midgut malrotation during fetal development, is recognized as the most frequent internal hernias. Two variants have been described: left and right, the latter less common than the first one.PRESENTATION OF CASEWe report a right paraduodenal hernia case in a 86 years old female patient who developed an acute bowel obstruction syndrome. Final diagnosis was achieved by imaging techniques as abdomen X-ray and CT and confirmed only after surgical operation.DISCUSSIONSurgical approach was via median laparotomy, consisting in hernia reduction, replacement and stitching of the bowel in its anatomical orientation, and fixing of the posterior wall defect. At 15 months follow-up from surgical procedure the patient is asymptomatic.CONCLUSIONParaduodenal hernia is a rare pathology but its involvement in bowel obstruction syndrome should be always taken into account during diagnostic process.     

Spigelian hernia associated with strangulation of the small bowel and appendix

Spigelian hernia is a rare lateral ventral abdominal hernia. These clinically elusive hernias are treacherous and have a real risk of strangulation. We present a patient with a strangulation of the small bowel and appendix in a right spigelian hernia, which was accurately demonstrated by spiral computerised tomography preoperatively and successfully treated with primary suturing reinforced with polypropylene mesh. With a high index of suspicion and the use of modern radiological technique, these "bewildering" hernias can be diagnosed and repaired relatively safely.     

Laparoscopic management of paraduodenal hernias: mesh and mesh-less repairs. A report of four cases

Background  Paraduodenal hernias are the most common form of internal hernias. There are few reports in the literature, with the total number of reported cases being less than 500. We report four patients with paraduodenal hernias causing intestinal obstruction. Materials and methods  All of the four patients with paraduodenal hernias presented with features of intestinal obstruction. A clinical diagnosis was not made in any of the cases, and computed tomography (CT) scanning was performed to confirm this. They were all successfully managed by a laparoscopic repair. Results  The operating time was 55–72 mins. Postoperatively, three patients recovered uneventfully, while one patient had ileus for 3 days and, thereafter, recovered spontaneously. Hospital stay was in the range 2–6 days. There were no conversions. One patient had recurrent paraduodenal hernia, for which a laparoscopic mesh repair was successfully performed. Discussion  The mechanism of the herniation is thought to be a defective rotation of the superior mesenteric vein during embryonic development. Paraduodenal hernias are not high on the list of differentials for bowel obstruction. Some form of surgery is mandatory for all cases. The inferior mesenteric vein has to be sacrificed in some cases to facilitate reduction of the hernia contents. A mesh repair is reserved for large defects and recurrent hernias. Laparoscopic repair has been infrequently reported in the literature. Based on our experience, the laparoscopic approach seems to be effective in the repair of paraduodenal hernias. It carries all of the benefits of minimal access surgery, while providing a sound repair.