Diagnóstico y manejo de la hernia paraduodenal / Diagnosis and management of paraduodenal hernia

Internal hernias cause 1 percent of intestinal obstructions with aproximately 50 percent of these hernias been paraduodenal hernias. Paraduodenal hernias are the product of a malrotation of the midgut during embryogenesis or a non-fusion of the peritoneal folds. These type of internal hernia are more cornmon in males and on the left side of the abdomen. The usual presentation age is in the 4th decade of life. The clinical presentation of these patients is non specific and varies, ranging from mild dyspepsia to intestinal perforation and septic shock. The radiographic studies of these patients show a dumping of the intestinal loops on the upper quadrant of the abdomen with an image of abdominal compartamentalization. The surgical management of these patients should follow three simple principles. The intestines should be reduced, their perfusion and viability must be verified and the hernia sack entrance should be repaired with interrupted non absorbable sutures.

Las hernias internas causan el 1 por ciento de las obstrucciones intestinales. De estas, aproximadamente la mitad son causadas por hernias paraduodenales. Las hernias paraduodenales son producto de una embriogénesis defectuosa, donde el intestino no rota o los pliegues mesentéricos no se fusionan adecuadamente. Estas hernias son más comunes en el género masculino, del lado izquierdo y por lo general se diagnostican en la cuarta década de la vida. La presentación clínica es inespecífica con manifestaciones que varían desde la dispepsia hasta la perforación intestinal y el choque séptico. Los estudios de imagen muestran el agrupamiento de las asas intestinales en el abdomen superior dando una imagen de compartamentalización de la cavidad abdominal. Para el manejo quirúrgico de estos pacientes se debe reducir el intestino herniado, verificar que este sea viable y posea una adecuada perfusión y reparar el orificio hemiario con material no absorbible.

Left Paramesocolic Hernia Presenting as Post Appendicectomy Abdominal Cocoon.

We describe a rare case of left mesocolic hernia presenting as post appendicectomy intestinal obstruction in a girl. Laparotomy confirmed partial peritoneal encapsulation of upper small bowel due to herniation of jejunal loops into the left mesocolic hernia sac. Reduction of contents, resection of the sac and repair of the defect concluded the procedure uneventfully.

Paraduodenal Hernia

Internal abdominal hernias are an unusual cause of intestinal occlusion. They are responsible for 2% of all the intestinal obstructions. Various types of hernia have been described. Paraduodenal hernias are relatively rare congenital malformations and result from incomplete rotation of the midgut with entrapment of the small intestine beneath the developing colon. We report a case of paraduodenal hernia of the small intestine in a 32-year-old man with presentation of intestinal obstruction. The patient suffered from nausea, vomiting and acute abdominal pain for 9 hours. Abdominal CT showed sac-like mass of clustered, dilatated small bowel in the right upper quadrant. At operation, herniation of small intestine into a retroperitoneal space through a defect on right mesocolon was noted. A right paraduodenal (mesocolic) hernia was diagnosed. The patient made an uneventful recovery except some diarrhea after extensive segmental resectio of strangulated small bowel. Paraduodenal hernia is important as it usually presents as intestinal obstruction, and is often misdiagnosed before laparotomy. Mortality is increased significantly with delays in surgical treatment. Though rare, paraduodenal hernia should be taken into account in a differential diagnosis of intestinal obstruction. Early surgical intervention allows uneventful recovery and also prevents the possible complication of gangrenous bowels.

Perforated Cecal Diverticulitis with Right Mesocolic Hernia

Mesocolic hernias are rare congenital anormalies resulting from abnormalities in the intestinal rotation during embryonic development, and comprise approximately 53% of all congenital internal hernias. A right mesocolic hernia is formed by the arrest of further rotation of the prearterial segment of gut in the right side of the abdomen, with continued rotation of the postarterial segment, during the second stage of embryonic intestinal rotation, leading to the entrapment of almost the entire small bowel behind the right colonic mesentery. The condition may be discovered incidentally during at laparotomy, or may be the cause of an acute small bowel obstruction. Cecal diverticulitis is a rare disease, whose symptoms are similar to acute appendicitis. It is difficult to diagnose the two diseases accurately prior to operation. We report on a 48-year old man, who had perforated cecal diverticulitis and an incidental right mesocolic hernia, with a review of the literature.

Congenital Mesocolic Hernia

Mesocolic hernia is a rare congenital anomaly caused by an error of rotation of the midgut. It may be seen as total encapsulation of the small bowel or a single loop within a hernial sac. It may be asymptomatic or cause life-threatening intestinal obstruction. Symptoms, when present, are often chronic vague abdominal pain and intermittent obstructive episodes. We have encountered a 40-year-old woman with a congenital mesocolic hernia. Abdominal CT provided the diagnosis. She successfully underwent operation and discharged with good condition. Now we present a case of congenital mesocolic hernia with a review of some articles.