An incarcerated paraduodenal hernia of a malrotated gut in a 26-year-old man.

Introduction and importance: Paraduodenal hernias (PDHs) are congenital internal hernias. Overall, internal hernias are between 0.2 % and 0.9 %, while 53 % of these statistics are for PDH. There are left and right types of PDHs. CASE PRESENTATION: An otherwise healthy 26-year-old man was presented with a sudden-onset epigastric and right upper quadrant abdominal pain. Abdominopelvic double contrasted CT scan revealed multiple dilated proximal-mid small bowel loops in the portal venous phase consistent with small bowel obstruction, suggesting concomitant bowel malrotation with internal paraduodenal hernia. The patient with the pre-operative diagnosis of small bowel obstruction due to volvulus was scheduled for emergency surgery. He was four weeks complication-free in his regular follow-up. CLINICAL DISCUSSION: In 1857, Treitz first described PDH as a phenomenon when the primitive midgut in embryonic life abnormally rotates and causes mesocolic hernia. The location of the duodenal recess is the origin point for describing the hernia; thus, the jejunum is the most common herniating viscus. However, the stomach, small intestine, and sometimes the colon usually consist of the contents of the hernia. CONCLUSION: In the absence of surgical history, abdominal wall hernia, and intra-abdominal inflammatory disease, in case of repeated abdominal pain or intestinal obstruction, and if no other causes are found, the possibility of a PDH should be kept in mind.

The effect of acidic beverage versus mineral water on the change in serum phenobarbital concentrations: a randomized clinical trial on children with seizure.

OBJECTIVE: To assess the effect of an acidic beverage (Orange juice) on the change in serum Phenobarbital concentrations in children with seizure who take Phenobarbital as the main treatment. METHODS: We did a parallel design and placebo controlled randomized clinical trial. Patients attending Heshmatiyeh Hospital (Iran) were recruited from October 2016 to December 2017. Forty patients randomly assigned to either experimental group or control group. Firstly, 5 mL blood sample was taken from both groups to measure serum Phenobarbital concentration before experiment. Then, one oral dose of Phenobarbital (2.5 mg/kg) with 100 mL of corporate Orange juice (pH = 3.5) (experiment group) or 100 mL of mineral water (neutral pH) (control group) was given to each group, respectively. After 2 h of administration, another blood sample was taken. The high-performance liquid chromatographic system was used for measurement of serum Phenobarbital concentration. RESULTS: There was significant increase in serum Phenobarbital concentrations after taking Phenobarbital in experiment group in comparison to control group. Statistical analysis revealed a significant increase in change of serum Phenobarbital concentrations in experiment group versus control group. CONCLUSION: The results of the current trial indicate that the level of serum Phenobarbital in the experiment group was higher than that of control group.