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Right Paraduodenal Hernia in an Adult Patient: Diagnostic Approach and Surgical Management

2011

Paraduodenal hernia, a rare congenital anomaly which arises from an error of rotation of the midgut, is the most common type of intraabdominal hernia. There are two variants, right and left paraduodenal hernia, the right being less common. We report the case of a 41-year-old patient with a right paraduodenal hernia with a 6-month history of intermittent episodes of intestinal obstruction. Diagnosis was established by CT scan and upper gastrointestinal series with small bowel follow-through. In a planned laparotomy, herniation of the small bowel loops through the fossa of Waldeyer was found. Division of the lateral right attachments of the colon opened the hernia sac widely, replacing the pre-and postarterial segments of the intestine in the positions they would normally occupy at the end of the first stage of rotation during embryonic development. Six months after the surgery, after an uneventful recovery, the patient remains free of symptoms.

An interesting case of left paraduodenal hernia

The Professional Medical Journal, 2021

Paraduodenal fossa hernias (PDFHs) represent 53% of all congenital internal hernias and 0.2-0.9% of all small bowel obstructions. Most of these hernias are diagnosed incidentally on laparotomy, and carry up to 50% lifetime risk of development of small bowel obstruction. We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia in a 17 year male, containing over 30% of the small bowel (jejunum and ileum), presenting with a history of recurrent incomplete small bowel obstruction. Plain abdominal radiography showed distended loops of jejunum and few air fluid levels. After laparotomy and identification of hernia, small gut was reduced and examined, which was found to be structurally and functionally intact with normal vascularity. The defect was closed with continuous absorbable suture (Vicryl 2-0) sparing the inferior mesenteric vessels. Patient’s post-operative recovery remained uneventful and he was discharged on 4th post-operative day.

Right paraduodenal hernia: report of two cases and review of literature

Gastroenterology Report, 2014

Paraduodenal hernia (PDH), a rare congenital anomaly, is a type of internal hernia which occurs due to a defect in the reduction and rotation of the midgut. On anatomical and embryological basis, PDH can be broadly divided into right-and Left PDH. Right PDH is rarer than its counterpart. We present two cases of Right PDH. The patientsy presented with a history of recurrent intestinal obstruction since childhood, which was managed conservatively, without a definitive diagnosis. Once they presented to us, a detailed clinical history and a barium meal follow-through clinched the diagnosis of PDH. Intra-operative findings correlated well with the clinical diagnosis. The jejunal loops had herniated through the fossa of Waldeyer. Reduction of hernia contents and excision of the hernia sac was carried out. Post-operatively, the patients are healthy and symptom-free at 4 and 3 years follow-up, respectively. The rarity of this condition and the need for early diagnosis, to prevent the high risk of bowel obstruction and strangulation, makes PDH one of the difficult challenges for the clinicians.

Complicated Right Paraduodenal Hernia - a Case Report

Paraduodenal hernia, a rare congenital anomaly that arises from an error of rotation of the midgut, is the most common type of intra-abdominal hernia. There are two types, right and left paraduodenal hernia, the right being less common. We report the case of a 41-year-old patient with a right paraduodenal hernia who presented with two days history of continuous pain abdomen with multiple episodes of vomiting. Patient was decided to undergo laparotomy in view of increasing abdominal pain and development of peritonitis. In a planned laparotomy, herniation of the small bowel loops through the fossa of Waldeyer, behind the ascending mesocolon was found which was gangrenous with prolapse of a few gangrenous loops into the peritoneal cavity. The gangrenous bowel resected, and an end to end jejunoileostomy performed.

Left-Sided Paraduodenal Hernia: Report of a Case

Surgery Today, 2006

Paraduodenal hernias are rare congenital malformations consisting of incomplete rotation of the midgut, which may lead to intestinal obstruction or simply be detected as an incidental finding at autopsy or laparotomy. We report a case of left paraduodenal hernia diagnosed preoperatively by computed tomography and operated on in an emergency setting for signs of peritoneal irritation. A misdiagnosis had been made when the patient suffered his first attack 6 months earlier and he had been treated for familial Mediterranean fever. We reduced the small bowel loops from the left paraduodenal hernia sac with ligation and transection of the inferior mesenteric vessels. The patient was discharged from hospital on postoperative day 4 after an uneventful recovery.

Left paraduodenal hernia: Embryological and radiological findings

South African Journal of Radiology

Left paraduodenal hernia (PDH), may present as a surgical emergency with an increased risk of strangulation and incarceration. The diagnosis is challenging because of the non-specific presentation. In the absence of common epigastric or upper abdominal pathology and non-resolving symptoms, a high index of suspicion is required to diagnose left PDH. This report describes a case of radiologically diagnosed left paraduodenal hernia and subsequent successful surgery. It also includes a review of midgut embryology, and the anatomy and radiology of left PDH.

Paraduodenal Hernia- an Obscure and Perilous Cause of Intestinal Obstruction

International Journal of Medical and Biomedical Studies

Paraduodenal hernias (PDH) constitute more than half of internal hernias. Both left and right PDH occur due to error of rotation of gut and defective fusion of mesocolon and mesentery with posterior parietal peritoneum. Clinical diagnosis of PDH is very difficult because of its varied presentation and nonspecific symptoms. Prompt diagnosis and surgery is imperative to avoid strangulation of bowel which is associated with high mortality. Before the advent of CECT many were discovered during exploratory laparotomy or unrelated abdominal surgery. Now CECT abdomen has become the gold standard for pre-operative diagnosis of PDH. We report two cases of PDH, one on left side and another on right side, diagnosed preoperatively and treated successfully. Keywords: Paraduodenal hernia, Mesocolic hernia, Treitz hernia, Internal hernia

Rarely seen left paraduodenal hernia case

ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE, 2017

The paraduodenal hernia, is formed by a potential cavity next to the ligament of Treitz and malrotation of the midgut. These hernias, which are the most frequently seen type of internal hernia, are responsible for approximately 1% of small intestine obstructions. A patient was admitted to the emergency room with complaints of abdominal pain and the inability to defecate. A computed tomography cross section that passed through the abdominal right upper quadrant, adjacently to the duodenal intestinal ansae within a hernia sac, showed a portion of the transverse colon and dilated mesenteric vascular structures. The patient underwent an exploratory operation that showed an orifice of approximately 3 cm in the ligament of Treitz and a shifting of almost all the small intestines and a portion of the transverse colon to the paraduodenal surface. The herniated structures were reduced at that point and the defect from the ligament of Treitz was sutured with non-absorbable suture material and closed. The paraduodenal hernia is a rare cause of intestinal obstruction but may result in late diagnosis and life threatening conditions such as intestinal gangrene. A patient with an intestinal obstruction who has not undergone a previous abdominal procedure should be considered as potentially having a paraduodenal hernia and should be immediately diagnosed in order to undergo surgical treatment.

Left Paraduodenal Hernia: Case Report and Literature Review

Indian Journal of Mednodent and Allied Sciences, 2014

Paraduodenal hernia is the most common form of congenital internal hernia and constitutes a protrusion of bowel into the retroperitoneal space through peritoneal defects near the third and fourth portion of the duodenum. The lifetime risk of obstruction and bowel strangulation is around 50% with a mortality of 20% and higher. Despite the rarity of the disease, it poses a serious surgical problem. The high risk of obstruction and the associated mortality mandate repair once the diagnosis is established. We present the interesting case of a 24-year-old woman with a left paraduodenal hernia who presented with abdominal pain and vomiting and underwent subsequent laparotomy with hernia repair. The purpose of this paper is to review the etiology, pathology, diagnosis and treatment of paraduodenal hernia and to heighten the awareness of this rare but significant disease.

Intestinal obstruction due to a left paraduodenal hernia: a case report

Journal of Medical Case Reports, 2013

Introduction: A left paraduodenal hernia is a rare congenital malrotational anomaly of the midgut that occurs in the paraduodenal fossa of Landzert to the left of the fourth duodenum. It is responsible for approximately 1% of small bowel obstructions. Case presentation: We report a case of left paraduodenal hernia combined with small bowel obstruction in a 47-year-old Mediterranean woman who had a history of recurrent abdominal pain. An abdominal computed tomography scan showed a saclike mass clustered in the left upper quadrant but failed to yield a clear diagnosis. We describe the surgical anatomy of this disease and the emergency surgical management together with a short review of the literature. Conclusions: Even though a left paraduodenal hernia is rare, it must be suspected in any upper intestinal occlusion. The high morbidity and mortality rate of complicated cases should motivate preventive treatment in case of incidental operative discovery.