Laparoscopic treatment of acute small bowel obstruction due to left paraduodenal hernia: A case report and literature review (original) (raw)
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An uncommon cause of acute bowel obstruction: the left para-duodenal hernia
Nigerian journal of surgery : official publication of the Nigerian Surgical Research Society, 2012
Internal hernias of the abdomen are uncommon. They represent less than 1% of bowel obstruction cases. The left Paraduodenal hernia (PH) is the most frequent type of internal hernias. We report a case of 77 year- old woman consulting for bowel obstruction evolving since two days. The abdominal computed tomography revealed a retroperitoneal small bowel contained in a peritoneal sac. The surgical exploration confirmed the diagnosis of a left internal PH by showing incarcerated jejunal loops in a PH through a narrow opening to the left of the angle of Treitz. A surgical reduction of the hernia and closure of the hernia neck were performed. The follow-ups were uncomplicated. Through this observation and a literature review, we try to recall the clinical and radiological characteristics of this disease and to clarify the therapeutic modalities.
World Journal of Emergency Surgery, 2013
Introduction: An internal hernia is a protrusion of bowel through a normal or abnormal orifice in the peritoneum or mesentery. Although they are considered as a rare cause of intestinal obstruction, paraduodenal hernias are the most common type of congenital hernias. Methods: A literature search using PubMed was performed to identify all published cases of left paraduodenal hernia (LPDH). Results: In Literature search between 1980 and 2012 using PubMed revealed only 44 case reports before the present one. Median age was 47 years (range 18-82 years). Nearly 50% reported previous mild symptoms. Two-third of patients required emergency surgery in form of laparotomy or laparoscopic repair. Reduction of hernia contents with widening or suture repair of the hernia orifice were the most common standards in surgical management of LPDH. Conclusion: Intestinal obstruction secondary to internal hernias is a rare presentation. High index of suspicion and preoperative imaging are essential to make an early diagnosis in order to improve outcome.
A rare case that caused high-level intestinal obstruction: left paraduodenal hernia
Turkish Journal of Surgery, 2013
The aim of this report is to assess clinical findings and surgical treatment of left paraduodenal hernia, which is an unusual type of internal herniation, in light of the literature. The diagnosis and treatment course of a 42-year-old male patient with findings of intestinal obstruction was assessed and presented together with literature search. The patient underwent surgery with a preliminary diagnosis of intestinal obstruction and the definitive diagnosis of internal herniation was made intraoperatively. Nearly two-thirds of the small intestine was found to be herniated into the retroperitoneal space from the left paraduodenal region. Small bowel loops were pulled out of the hernia sac and anatomically positioned in the intraperitoneal area. The hernia sac was repaired primarily. The patient was discharged on the fourth postoperative day, uneventfully. Left paraduodenal hernia should be considered as a part of differential diagnosis in patients who have recurring abdominal pain episodes accompanied by symptoms suggestive of intestinal obstruction. Timely diagnosis is important to prevent complications. Reduction of hernia content followed by primary repair of the defect appears to be a safe and effective treatment.
Left paraduodenal hernia causing acute small bowel obstruction
Arab Journal of Gastroenterology, 2010
Paraduodenal hernias are rare fascinating variety of hernias that arise in the potential spaces and folds of the posterior parietal peritoneum adjacent to the ligament of Treitz. These may present with chronic intermittent abdominal pain, acute small bowel obstruction or bowel ischaemia. Treatment is by surgery. We present a case of a 32-year-old male who had previously presented to us on multiple occasions with abdominal pain that had always relieved by its own. Only this time he presented with acute intestinal obstruction. The anatomy, management and significance of considering this uncommon diagnosis while examining a patient with acute small bowel obstruction are discussed.
Surgical laparoscopy, endoscopy & percutaneous techniques, 2012
An internal hernia is any protrusion of a solid organ or a hollow viscus through a defect within the abdominal cavity. Paraduodenal hernias (PDHs) are rare; however, they are the most common form of internal hernias. We present a case of a left PDH in a 59-year-old healthy woman who presented with acute bowel obstruction. The PDH was diagnosed preoperatively using computed tomography scan. Laparoscopic exploration of the abdomen was then performed for reduction of the hernia. Using this approach, we managed to close the defect with intracorporeal continuous suturing with the aim of avoiding future incarceration. The patient was discharged 60 hours postoperation in a good condition, compared with 3 to 28 days postoperation reported in most of the literature. Our search of the english language literature revealed only 16 reported cases of laparoscopic repair of PDH. We believe that laparoscopic treatment of PDH in experienced hands is recommended in selected cases as it decreases the ...
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
Left Para duodenal Hernia: Case Report of Rare Cause of Small Bowel Obstruction
EAS Journal of Medicine and Surgery, 2022
Para duodenal 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. We present the case of a 32-year-old female patient presented with a seven-day history of generalized intermittent colicky abdominal pain accompanied by multiple episodes of bilious vomiting. She was otherwise healthy and had no history of previous abdominal operations. Computed tomography scan of the abdomen demonstrated sac-like clustered small bowel loops noted in the left upper quadrant, in the anterior para-renal space, consistent with the diagnosis of left Para duodenal hernia. Exploratory Laparotomy for the repair of the hernia was planned. The jejunal loops had herniated through the fossa of Waldeyer. Reduction of hernia contents and excision of the hernia sac was carried out. The patient tolerated the procedure without complications, and she was asymptomatic in the follow-up visit. This case sheds light on the importan...
Small bowel obstruction secondary to paravesical hernia
BACKGROUND: Bowel obstruction in the setting of the unscarred abdomen can be due to a wide variety of causes. Internal hernias are a rare cause of bowel obstruction with paravesical hernia being exceedingly rare. Paravesical hernia should form part of the differential diagnosis in the patient presenting with bowel obstruction. Prompt management and reduction of the incarcerated bowel are essential. This will prevent further complications especially related to bowel ischemia. CASE SUMMARY: The patient presented with a classical history of small bowel obstruction. Abdominal Xray revealed distended loops of small bowel and absence of air in the rectum. An exploratory laparotomy revealed a paravesical internal hernia. A loop of terminal ileum had incarcerated and was the cause of the bowel obstruction. The defect was repaired after reducing the bowel and the patient made an uneventful recovery. CONCLUSION: Internal paravesical hernia although extremely rare should form part of the differential diagnosis in the patient presenting with small bowel obstruction especially in the previously unscarred abdomen. If the obstruction is complete then prompt exploration via laparotomy or laparoscopy is required. Delays in definitive management may result in marginally viable bowel becoming ischemic and requiring bowel resection.
A rare cause of small bowel obstruction in adults: left paraduodenal internal hernia
2012
A 47 years old lady presented with repeated intermittent, colicky, left upper, and periumblical abdominal pain associated with nausea and vomiting since two years prior to admission. Each episode of the pain spontaneously subsided after bilious vomiting. The patient had no history of surgery, abdominal trauma or intra-abdominal infection, weight loss or previous history for small bowel obstruction (SBO). MRI enterography was suggestive of internal hernia and surgery documented left paraduodenal (mesocolic) internal hernia (LPDIH). After surgery the patient was followed for three months without any abdominal symptoms. KEywORDS Congenital hernia; Paraduodenal (mesocolic) internal hernia; Small bowel obstruction (SBO).