Laparoscopic management of a small bowel obstruction: paraduodenal hernia

Paraduodenal hernia are very rare but the commonest internal hernia. Left paraduodenal hernia is due to herniation of the small bowel into the fossa of Landzert. The fossa results from a combination of failure of fusion of the small bowel mesentery with the retro peritoneum and malrotation of the midgut. Here we present a 27 years lady who saw multiple consultants with varied presentations and underwent extensive investigations over a one-year period, with one consultant referring her to a psychiatrist for malingering. CT scan revealed a foramen of Winslow hernia. The radiologist has to be aware of the CT findings of this unusual hernia. At laparoscopy, it was a left paraduodenal containing small bowel. We reduced the contents and plicated the sac with closure of the mouth. Patient did well and was discharged on 3rd post-operative day. On follow up she is doing well.

Laparoscopic management of left paraduodenal hernia: a rare case report

An internal hernia is any protrusion of a solid organ or a hollow viscus through a defect within the abdominal cavity. Paraduodenal hernias are rare, but are the most common variety of internal hernias. We present a rare case of a left sided paraduodenal hernia in a 26 years old otherwise healthy male who presented in emergency department with intermittent colicky upper abdominal pain. Left paraduodenal hernia was diagnosed pre operatively in a computer tomography scan. Hence patient was offered a laparoscopic repair. Our search via online search engines revealed very few case reports of Paraduodenal hernias which were repaired laparoscopically. We believe that in expert hands, paraduodenal hernias should be managed with laparoscopic technique as it significantly reduces morbidity and hospital stay.

Diagnosis and treatment of paraduodenal hernia / 中国基层医药

Objective To sum up the experience of diagnosis and treatment of paraduodenal hernia. Methods The clinical data of 18 cases of paraduodenal hernia treated by surgery were analyzed retrospectively. Results The average age of the patients was 34 years old.There were 15 cases with left paraduodenal hernia and 3 cases with right paraduodenal hernia.Ten patients usually had no clinical symptoms,while acute abdominal pain occurred after full food in 7 cases,and after vigorous movement in 10 cases respectively.Abdominal X-ray revealed complete or incomplete intestinal obstruction in 16 cases,while abdominal CT revealed abnormal cystic loops of small intestine between the pancreas and the stomach in 10 cases.All 18 cases underwent surgical operation,recovered 10-15 days after operation.After 2-8 years follow-up,there was no hernia recurrence.Conclusion Paraduodenal her-nia is difficult to diagnosis before operation,and the key to correct diagnosis and treatment is to explore the positive exploratory laparotomy.

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 Paraduodenal Hernia Presenting with Atypical Symptoms

Paraduodenal hernias are a rare congenital malformation, but they are the most common internal hernias. They develop secondary to a failure in midgut rotation, which may lead to small bowel obstruction or other clinical manifestations. The authors recently experienced a case of a left paraduodenal hernia presenting with unusual symptoms of left flank pain and vomiting.

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.

Clinical Analysis of an Acute Intestinal Obstruction with a Paraduodenal Hernia

PURPOSE: A paraduodenal hernia is an uncommon congenital disease that manifests as an intestinal obstruction, which may lead to strangulation and, subsequently, result in gangrene of the intestine. In this retrospective study, 12 paraduodenal hernia cases were evaluated and the clinical prognostic factors investigated. METHODS: Paraduodenal hernias leading to intestinal obstructions were noted in 12 patients. The patients were retrospectively evaluated with respect to signs and symptoms. The laboratory and radiological findings, type of operation, time elapsed between the onset of symptoms and laparotomy and postoperative complications and hospital stays were also reviewed. The relationships between clinical factors and outcomes were also statistically evaluated. RESULTS: In our series, postoperative short bowel syndrome was encountered in one patient (case 1) with bowel strangulation, but there were no mortalities. The time elapsed between the onset of symptoms and laparotomy was found to be longer in the patients with strangulation than in those without (6.8+/-4.5 day versus 4.1+/-3.6 day). Additionally, the postoperative hospital stay was longer in those patients with strangulation (24.4+/-11.6 day versus 15.3+/-7.7 day), but the relationship was not statistically significant (P=0.283 and 0.130, respectively). CONCLUSION: Since the preoperative diagnosis of a paraduodenal hernia is very difficult, due to the lack of specific signs and symptoms, the postoperative complications can only be decreased with early surgical intervention in those patients with an acute intestinal obstruction. Although the postoperative morbidity and mortality were not correlated with any of the factors evaluated in this study, further study will be needed to evaluate the significance of the time elapsed between the onset of symptoms and a laparotomy as a prognostic factor.

Left paraduodenal hernia presenting as intestinal obstruction: A case report.

A case report of left paraduoenal hernia in an 18-year-old man presenting with complete small intestinal obstruction. This patient suffered from intermittent colicky abdominal pain for 10 days. The pain worsened over the 2 days before admission. He also had bilous vomiting and obstipation. He was diagnosed with complete small intestinal obstruction and sent for an emergency exploratory laparotomy. At operation, he was found to have a left paraduodenal hernia. The small bowel could be reduced manually into the normal position and the neck of the hernial sac was closed. He made an uneventful recovery after the operation and was discharged from hospital 4 days later. Although paraduodenal hernia is a rare cause of small intestinal obstruction, it should be taken into account in the differential diagnosis of small intestinal obstruction especially in a patient with no previous abdominal exploration. Early surgical intervention could prevent the possible complication of gangrenous bowel.

Paraduodenal Hernia

Paraduodenal hernia is a rare congenital anomaly caused by abnormal rotation of the midgut in embryonic stage, with part of the small intestine becoming trapped posterior to the mesocolon. Right and left paraduodenal hernias are distinct and separate entities, varying not only in anatomical structure but also in embryological origin. Paraduodenal hernia is a rare cause of acute intestinal obstruction. Careful clinical evaluation is needed for prompt surgical treatment. Because it is difficult to diagnose before exploration, and since paraduodenal hernia may cause potentially lethal complications such as obstruction, gangrene or bowel perforation, the possibility of internal hernia should be considered in any patient with acute intestinal obstruction who has no previous abdominal operation or external hernia. If paraduodenal hernia is suspected to be the cause of acute intestinal obstruction, the recommended tool for diagnosis is abdominal computed tomography. We experienced three cases of paraduodenal hernia, one case was right paraduodenal hernia while the others were left paraduodenal hernia.