Laparoscopic left paraduodenal hernia repair: A case report.

Paraduodenal hernias (PDH) pose a diagnostic challenge due to their varied presentations and rarity. We report a rare case report illustrating the clinical course, diagnostic approach, and management of PDH in a 19-year-old female patient with a history of neonatal laparotomy for intestinal atresia. The patient initially presented with chronic, diffuse abdominal pain, which had progressively worsened over 2 years. Physical examination revealed no palpable mass, with normal bowel sounds and vital signs. Imaging studies, including computed tomography of the abdomen, demonstrated protrusion of small bowel loops in the left upper abdominal quadrant consistent with a left paraduodenal hernia. Following laparoscopic exploration, a large defect was identified, and successful repair was performed, resulting in resolution of symptoms and a smooth postoperative recovery. Our case highlights the importance of maintaining a high index of suspicion for PDH in patients with chronic abdominal pain, particularly those with a history of abdominal surgeries. Prompt diagnosis and timely surgical intervention, preferably laparoscopic, can lead to favorable outcomes and improved quality of life for affected individuals.

Unusual causes of Small bowel obstruction: a review of the literature and revisited cross-sectional imaging checklist.

Intestinal obstruction is a common surgical emergency with high morbidity and mortality. Patients presenting with features of small bowel obstruction need urgent evaluation to avoid complications such as bowel gangrene, perforation, or peritonitis. Imaging is necessary in most cases of suspected bowel obstruction, to take an appropriate decision, for apt patient management. Among the common causes of small bowel obstruction, adhesions, external herniae, malignancies, and Crohn's disease top the chart. Imaging helps in determining the presence of obstruction, the severity of obstruction, transition point, cause of obstruction, and associated complications such as strangulation, bowel gangrene, and peritonitis. This review is based on the cases with unusual causes of bowel obstruction encountered during our routine practice and also on the extensive literature search through the standard textbooks and electronic databases. Through this review we want our readers to have sound knowledge of the imaging characteristics of the uncommon yet important causes of bowel obstruction. We have also revisited and structured a checklist to simplify the approach while reporting a suspected case of small bowel obstruction. Imaging plays a key role in the diagnosis of small bowel obstruction and in determining the cause and associated complications. Apart from the common causes of small bowel obstruction, we should also be aware of the uncommon causes of small bowel obstruction and their imaging characteristics to make an accurate diagnosis and for apt patient management.

Mesocolic hernia, a case series.

INTRODUCTION AND IMPORTANCE: Paraduodenal hernias are difficult to diagnose due to their unusual presentation. Herein, five new cases are added to the literature. CASE PRESENTATION: Four male and one female child complained of paraduodenal hernias, two on the right side and three on the left side. The intestinal part that herniated inside the hernia sac was also malrotated in four patients. One patient had Meckel's diverticulum with a herniated intestine. One infant had extrahepatic biliary disease, a single atrium, polysplenia, intestinal malrotation, and a left paraduodenal hernia. Exploratory labarotomy was done for reduction of the intestine, reorientation, and repair of hernia orifices. CLINICAL DISCUSSION: Paraduodenal hernia is a component of malrotation. Cautious dissection of the hernia orifice is required to keep away from injuries to the inferior mesenteric vein or left colic artery in the course of the restoration of the left paraduodenal hernia. Also, the superior mesenteric vessels may be injured in the course of the restoration of the right paraduodenal hernia. CONCLUSION: There is a correlation between the occurrence of PDH with malrotation. The diagnosis of malrotation can be made with an ultrasound abdomen; however, it is true that ultrasound cannot make a confirmed diagnosis in all patients. Once the diagnosis of a mesocolic hernia has occurred, surgical repair is mandatory by closure of the defect.

Right paraduodenal hernia presenting with strangulated obstruction with intestinal malrotation: a case report.

A paraduodenal hernia is a rare cause of an internal hernia that may require massive bowel resection; prompt diagnosis and surgical treatment are essential. In cases of malrotation, strangulation may occur both inside and outside the hernial sac. Strangulation outside the hernial sac makes the preoperative diagnosis more difficult. Herein, we report a patient with a right paraduodenal hernia, intestinal malrotation, and strangulation outside the hernia. An 86-year-old woman was admitted to our hospital with abdominal pain. Enhanced computed tomography showed a closed-loop obstruction of the hypo-enhancing small bowel and absence of a horizontal duodenal leg. The patient underwent an emergency laparotomy and was diagnosed with strangulated bowel obstruction due to a right paraduodenal hernia and malrotation. The patient underwent resection of the ischemic ileum, closure of the hernial orifice, and repositioning of the intestine. The postoperative course was uneventful. The patient reported no abdominal discomfort after 7 months of follow-up.

A Case Report on Internal Hernia as an Unusual Cause of Small Bowel Obstruction: A Diagnostic Triumph Unveiled by Computed Tomography Scan.

Paraduodenal hernia is a type of internal hernia caused by defects in the peritoneum during fetal development. It is one of the uncommon causes of intestinal obstruction; diagnosing it and intervening promptly are required. In this case report, we describe our experience treating an adult male patient who presented with symptoms of acute small bowel obstruction and was later diagnosed with internal hernia on further evaluation. The purpose of this case report is to demonstrate the importance of imaging modalities, particularly computed tomography (CT) scan, in diagnosing these cases. Because of their mysterious symptoms, paraduodenal hernias are usually diagnosed late or incidentally. Although they are uncommon, they are far more likely to cause bowel obstruction and strangulation. Immediate surgical intervention is required following the diagnosis.

When the Gut Took a Wrong Turn to the Right: A Case Report of a Rare Complication of Closed Loop Small Bowel Obstruction With Small Bowel Volvulus in a Right Paraduodenal Hernia With Midgut Malrotation.

Internal hernias constitute 5.8% of all small bowel obstructions. The right paraduodenal hernia is a less common subtype of the paraduodenal hernia. Lack of specific signs and symptoms precludes its clinical diagnosis, which emphasizes the need for computed tomography in diagnosis. We present a case of a 24-year-old male patient with a right paraduodenal hernia and midgut malrotation causing closed loop small bowel obstruction and small bowel volvulus within the hernial sac who underwent laparoscopy-assisted reduction of hernia and adhesiolysis with closure of the peritoneal defect. Since the right paraduodenal hernia is associated with gut malrotation, risk of strangulation, closed-loop obstruction, and rarely volvulus, these patients need prompt radiological diagnosis and surgical intervention.

Beyond the Common: A Case Report on Right Paraduodenal Hernia.

Paraduodenal hernias, particularly those on the right side, are rare but clinically significant occurrences characterized by the abnormal protrusion of abdominal contents through mesenteric defects adjacent to the duodenum. These hernias result from embryologic malformations and can lead to complications such as intermittent abdominal pain, nausea, and, in severe cases, bowel obstruction. This case describes a 48-year-old male who presented with a 24-hour history of colicky abdominal pain in the right upper quadrant, associated with nausea. Further investigation, including a computed tomography scan, revealed a right paraduodenal hernia with herniation of small bowel loops through a mesenteric defect. Timely surgical intervention via laparoscopic exploration confirmed the diagnosis and facilitated the reduction of herniated bowel, followed by meticulous repair of the mesenteric defect using nonabsorbable sutures. The patient's recovery was uneventful, with a return to normal bowel function, and postoperative follow-up showed the resolution of symptoms. This case underscores the clinical complexity and management challenges associated with right paraduodenal hernias. Surgical intervention, guided by laparoscopic exploration, emerged as an effective and minimally invasive approach. The successful reduction of herniated small bowel loops and meticulous closure of the mesenteric defect contributed to a favorable postoperative course, highlighting the importance of timely intervention to prevent complications.

A late presentation of a left paraduodenal hernia in an elderly patient admitted in emergency: A case report.

Small bowel internal hernias (IHs), a rare cause of small bowel occlusion (SBO) and small bowel strangulation, while more commonly seen in young adults, can also affect elderly patients and pose a significant diagnostic challenge due to their nonspecific symptoms. In most cases, laparotomy was used to diagnose IHs. However, multidetector computed tomography (MDCT) is usually the best imaging tool to use in the emergency setting for the diagnosis of IHs. An 83-year-old man was admitted to emergency with acute abdominal pain and a coffee-ground vomitus. The abdominal MDCT showed a clustered-like appearance of proximal jejunal loops at the level of the Treitz ligament with the absence of transit of the medium water-soluble iodine oral contrast agent (Gastrografin). Mesenteric edema was also present with initial suffering of the intestinal wall. A left paraduodenal hernia (LPDH) with strangulation was suspected following the radiological report. The emergency laparotomy revealed about 20 cm of proximal jejunal loops herniated through a 3 cm wide hernia orifice (HO) along the Treitz ligament, at the level of Landzert fossa, located in the confluence of the descending mesocolon, posterior to the inferior mesenteric vein (IMV) and confirming the LPDH. The patient was discharged in good condition some days later. IHs do not have sufficient coverage in literature, especially in cases regarding elderly patients, however, they can be a cause of SBO in people older than 80 years of age. Radiologists and surgeons should be aware of the anatomical aspects of the IHs.

Lessons learnt in the management of paraduodenal hernias: a case series.

INTRODUCTION: Paraduodenal hernias (PDH) are rare congenital internal hernias with non- specific symptoms. Left-sided paraduodenal hernia is three times more common than right-sided paraduodenal hernia with similar clinical presentation but different embryological origins. MATERIALS AND METHODS: We report a series of eight cases of paraduodenal hernia who presented with varied clinical presentation ranging from vague abdominal pain to complete intestinal obstruction. Six cases had left-sided paraduodenal hernia, while two cases had right-sided paraduodenal hernia. RESULTS: Seven cases based on their presentation underwent surgery either electively or on emergent basis. Three cases underwent laparoscopic repair. One case had a recurrence and was re-operated four months later. There was no mortality among any of the cases. CONCLUSION: A pre-operative diagnosis of paraduodenal hernia is essential. Laparoscopic surgery is safe in select cases and is found to be beneficial.

Right paraduodenal hernia, classification, and selection of surgical methods: a case report and review of the literature.

BACKGROUND: Considering that right paraduodenal hernia is a rare internal hernia with abnormal anatomy and is often encountered during an emergency, surgeons may lack knowledge about it and choose incorrect treatment. Thus, this case report is a helpful complement to the few previously reported cases of right paraduodenal hernia. Additionally, we reviewed all the reported right paraduodenal hernia cases and proposed appropriate surgical strategies according to different anatomical features. CASE PRESENTATION: The case involved a 33-year-old Chinese male patient who was admitted to the hospital due to abdominal pain. The patient was initially diagnosed with small bowel obstruction, and conservative treatment failed. An emergency operation was arranged, during which a diagnosis of right paraduodenal hernia was made instead. After surgery, the patient recovered well without abdominal pain for 2 years. CONCLUSION: Although right paraduodenal hernia accounts only for a small proportion of paraduodenal hernia, its anatomical characteristics can vary considerably. We divided right paraduodenal hernia into three types, with each type requiring a different surgical strategy.

From Recurrent Pain to a Life-Threatening Condition: A Case Report of Left Paraduodenal Hernia.

Paraduodenal hernia (PDH) is the most frequent type of congenital hernia, especially on the left side. Although acute intestinal obstruction due to internal hernias is rare, it can be life-threatening if not detected and treated promptly. Here, we present the case of a 36-year-old man who presented to the emergency department with an acute intestinal obstruction that had been developing for three days. The patient had a history of recurrent abdominal pain but had never undergone any abdominal surgery. Surgical exploration revealed a left internal PDH with a collection of incarcerated jejunal loops retrocolically encased within the hernial sac. Resection of the gangrenous jejunal loops was performed, followed by hernia reduction and neck closure. This case highlights the importance of timely and accurate diagnosis of left PDHs, particularly in patients with a history of recurrent abdominal pain and no prior abdominal surgeries. Early detection and treatment can prevent life-threatening complications such as intestinal perforation and peritonitis.

Rare Hernias as Surgical Emergencies: A Case Series of Five Cases.

Hernia is one of the most common clinically diagnosed cases seen in day-to-day practice. But some of them might pose a challenge in diagnosing the condition and, thus, their further management. Some types of hernias are rare and mimic the common presentation of the acute abdomen, thus requiring extra caution to keep hernias as a differential diagnosis in the acute abdomen. In this series, we report five cases of rare hernias presented to a tertiary care center in northern India over the course of one year. Two cases of paraduodenal hernias (PHs), a right and left, respectively, a male femoral hernia, an Amayand hernia, and an obturator hernia presented as acute abdomen in the emergency department, with challenges in their diagnosis, intraoperative findings, and their outcomes. Computed tomography is a useful diagnostic tool for arriving at the diagnosis pre-operatively in these situations.

Minimally invasive surgery for paraduodenal hernias: report of a case and mini-review of operative techniques.

BACKGROUND: Paraduodenal hernias (PDHs) are the most common congenital internal hernias. Herein, we present a successful laparoscopic repair of a left PDH and we review the minimally invasive techniques that have been used to treat PDHs. MATERIALS AND METHODS: An 18-year-old female patient with multiple visits to the emergency department for abdominal pain was ultimately diagnosed with a left PDH. She underwent a four-port laparoscopic repair. In order to review the minimally invasive PDH repair techniques used, we searched the PubMed® database and found 53 original studies with a total of 66 minimally invasive PDH repairs (51 left PDH repairs, 15 right PDH repairs) over a period of 24 years (1998-2022). RESULTS: The patient's postoperative course was uneventful and she was discharged on the 7th postoperative day. The literature review showed that closure of the hernia orifice was performed in 88% of left PDH repairs, whereas wide opening of the hernia orifice with or without mobilization of the right colon was performed in 81% of right PDH repairs. Of the patients with available postoperative data, none experienced complications other than grade Ι according to the Clavien-Dindo classification in the early postoperative period, and only one patient presented symptomatic hernia recurrence at a median follow-up of 1 year. CONCLUSIONS: Based on limited publications and our own experience, minimally invasive repair of PDHs has so far been shown to be feasible and safe in the great majority of cases without irreversible small intestine ischemia/peritonitis.

Extensive small bowel necrosis due to congenital para duodenal hernia: A diagnostic and therapeutic challenge: Case Report.

INTRODUCTION: A paraduodenal hernia is a rare variety of hernia, however it is the most usual type of internal hernias. Clinical presentation is nonspecific. The clinical presentation is variable: indeed, the patient can be completely asymptomatic or present with symptoms which severity is variable according to the mechanism. The most common cause is an acute intestinal occlusion that could progress even to ischemia and intestinal necrosis. Depending on the clinical presentation and the suspected diagnosis, computed tomography can be of considerable help in demonstrating a para duodenal hernia. CASE PRESENTATION: We describe the case of a young man aged 18 years, who presented to the emergency unit with severe abdominal pain associated with incoercible vomiting. The surgical exploration had confirmed a para duodenal hernia responsible for an extensive necrosis of the small intestine allowing viable 90 cm only. CASE DISCUSSION: Paraduodenal hernias are rare and their diagnosis is not always easy. Therefore, they should be considered especially in the case of an occlusive syndrome occurring in a young patient who has never been operated on. If no treatment is undertaken, the evolution is drastic and the mortality rate is significant. CONCLUSION: Successful surgical management requires knowledge of the intra-abdominal peritoneal spaces and management of suggestive clinical situations in order to reduce postoperative morbidity and mortality resulting from delayed diagnosis and treatment.

Large left paraduodenal hernia identified and repaired by laparoscopy: A case report.

Paraduodenal hernias (PDHs) are rare types of internal hernias that pose a significant diagnostic and therapeutic challenge because they can present with non-specific symptoms ranging from digestive disorders and chronic abdominal pain to symptoms of intestinal obstruction which may be life-threatening. We describe here a woman in her early 30's who presented to the emergency department with a three-hour history of generalized intermittent crampy abdominal pain. She had experienced multiple similar episodes of this pain over the past 20 years. Totally laparoscopic technique was used to complete the diagnosis and treatment of a large left PHD with accompanying acute intestinal obstruction. The operation was successful and the patient was discharged from hospital 10 days later. PDH should be considered if a patient complains of recurrent abdominal pain without any other obvious explanation; a laparoscopic approach can be used to identify and repair the hernia.

Fatal Bowel Obstruction Due to Paraduodenal Hernia: A Case Report.

A paraduodenal hernia is a rare type of hernia, however it is the most common type of internal hernias. It can develop after surgery, trauma, or be congenital. Paraduodenal hernias are rare in children. Clinical presentation is nonspecific. Patients range from being asymptomatic to presenting with clinical symptoms associated with small bowel obstructions. Diagnostic tools such as X-ray, plain abdominal radiography, and computed tomography may be used to diagnose paraduodenal hernias. Described is the case of a 5-year-old female who died suddenly of a bowel obstruction due to a paraduodenal hernia found at postmortem examination. In the hours prior to death, she reported stomach pain, vomiting, and later developed a fever. Postmortem CT study showed free fluid in the abdomen and bowel distention. Internal examination showed an obstructed bowel with ischemic sections extending from the distal portions of the small bowel up to the proximal portions of the transverse colon. The ischemic portions were entrapped within a clear membranous sac within the abdominal cavity. The sac was concluded to be a paraduodenal hernia. Paraduodenal hernias are rare and difficult to diagnose but they must be considered in the diagnostic process, as without surgical intervention the mortality rate can be high.

Laparoscopic correction of hydronephrosis caused by left paraduodenal hernia in a child with cryptorchism: A case report.

BACKGROUND: Paraduodenal hernia (PDH) is a mesenteric-parietal hernia with retroperitoneal and retrocolic herniation of the small bowel into a sac, which is formed by a peritoneal fold located near the fourth portion of the duodenum. The present case revealed that PDH was a possible reason for hydronephrosis, and that the carful laparoscopic exploration surgery was necessary to find infrequent causes of hydronephrosis to avoid invalid Anderson-Hynes pyeloplasty surgery and its injury. CASE SUMMARY: An 8-year-old boy presented to the pediatric department with a chief complaint of cryptorchidism. Afterwards, laparoscopy confirmed hydronephrosis secondary to left PDH with cryptorchid. Then, he received laparoscopic surgery, fixed operation for left PDH, release of the ureteropelvic junction obstruction, and treatment for hydronephrosis. It is necessary to perform secondary surgery for cryptorchidism and long-term follow-up. CONCLUSION: The case revealed an extremely rare cause of hydronephrosis in children, suggesting a potential correlation between PDH and hydronephrosis.

Incarcerated left paraduodenal hernia case report and literature review.

INTRODUCTION: Left paraduodenal hernia is an internal herniation that develops due to anomalous fetal development. If incarcerated, it becomes an unusual cause of acute abdomen. CASE REPORT: This case report presents an uncommon case of a 39-year-old man with acute abdominal pain with vomiting. The patients medical history included recurrent subileous events and Crohn´s disease in long-term remission. CT scan of abdominal cavity indicated a possible mechanical obstruction of small bowel loops in the upper left abdominal quadrant. Incarcerated left paraduodenal herniation was identified during surgery. Repositioned small bowel loops did not require resection and the entrance of Landzert´s fossa was sutured. CONCLUSION: Left paraduodenal hernia is the most common congenital internal herniation. Although rare, it should be considered in the differential diagnosis of acute abdomen.

A Left Paraduodenal Hernia: an "Incidental Finding" in a Virgin Abdomen with Small Bowel Obstruction.

BACKGROUND: A left paraduodenal hernia is a rare clinical condition, resulting from embryological abnormalities or anomalies of the peritoneal attachments. Preoperative diagnosis is difficult because of its nonspecific clinical manifestations. PRESENTATION OF A CASE: A 42-year-old man, with negative surgical history, presented to the emergency department with complaints of severe acute epigastric pain and vomiting of 12 h duration. The patient did not report any episodes of abdominal pain in his history. Computed tomography imaging was suggestive for a closed-loop obstruction. An emergency laparoscopy was performed, revealing a pathologically dilated tangle of jejunal loops and an incidental finding of a left paraduodenal hernia, the latter containing small bowel loops with normal caliber. The small bowel loops were reduced, and the hernia orifice was closed via non-absorbable sutures to restore normal anatomy. The pathologically dilated small bowel segment with serosal scar tissue, probably developed secondary to a previous episode of incarceration, was resected. RESULTS: A high level of clinical suspicion for a left paraduodenal hernia is advocated in patients with a virgin abdomen, presenting with recurrent vague abdominal pain or acute symptoms of small bowel obstruction. Usually, a left paraduodenal hernia is an incidental finding on computed tomography imaging or during diagnostic laparoscopy. Surgical repair is the mainstay therapy, even in asymptomatic cases, to prevent future small bowel incarceration which develops in almost half of the cases. The laparoscopic approach is feasible and safe, also in an emergency setting. CONCLUSIONS: By presenting this case, we assume to raise awareness as many clinicians are unfamiliar with this rare condition. Clinical suspicion and detailed knowledge of the etiology, anatomy, and vascular landmarks allow surgeons to accurately manage a left paraduodenal hernia.