A rare case that caused high-level intestinal obstruction: left paraduodenal hernia

Öztaş, Muharrem; Can, Mehmet Fatih; Öztürk, Erkan; Yağcı, Gökhan

doi:10.5152/ucd.2013.27

Cited by 3 publications

(1 citation statement)

References 12 publications

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“…LPDH represents herniation of the mesentery of the small intestine in the left paraduodenal or Landzert's fossa in the posteroinferior direction [11] , [12] . Restrictions of the paraduodenal fossa consist of the fourth segment of the duodenum (right), the left branches of the middle colic artery (anteriorly), the posterior parietal attachment of the descending colon mesentery (posteriorly), and the inferior mesenteric vein [13] , [14] . The cause of this opening is an embryonic disorder in terms of lack of connection of both peritoneal folds from the sixth to the eleventh week of gestation [7] .…”

Section: Discussionmentioning

confidence: 99%

Left paraduodenal hernia – A diagnostic challenge: Case report

Manojlović

Čekić

Palinkaš

2021

International Journal of Surgery Case Reports

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Introduction and importance Internal hernias represent the penetration of intestinal loops through congenital or acquired openings within the mesentery or peritoneum. One such hernia is the paraduodenal hernia, which is the most common type of internal hernia (53%) (Yun et al., 2010) [1] . Due to the variable and non-specific clinical presentation, it is difficult to make a correct diagnosis. Preoperative computed tomography of the abdomen facilitates diagnosis and timely surgical intervention, which can be performed openly or laparoscopically (Coakley et al., 2012) [2] . Case presentation In this paper, the case of a 39-year-old patient with left paraduodenal hernia will be presented. He arrived in the emergency department with sudden onset of abdominal pain. The diagnosis was established using computed tomography and an open surgical procedure was successfully performed. Discussion Clinical presentation of paraduodenal hernia ranges from asymptomatic to manifest. The greatest difficulty regarding management of paraduodenal hernias lies in their diagnosis. Many studies have shown that the best option for diagnosis is computed tomography (CT). Open and laparoscopic techniques are used in treatment of paraduodenal hernias with similar results. Conclusion The case of a 39-year-old male patient with LPDH with non-specific symptomatology was presented. CT scan is the best diagnostic option for this condition. Open surgical approach was used with great success.

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Section: Discussionmentioning

confidence: 99%

Left paraduodenal hernia – A diagnostic challenge: Case report

Manojlović

Čekić

Palinkaš

2021

International Journal of Surgery Case Reports

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Paraduodenal hernias: a systematic review of the literature

Schizas

Αποστόλου

Krivan

et al. 2019

Hernia

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A case report of left paraduodenal hernia diagnosed preoperatively and treated laparoscopically

et al. 2018

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Paraduodenal hernia is a rare congenital anomaly; however, it is the most common cause of internal herniation. Clinical findings are often indeterminate. Computerized tomography is usually diagnostic; however, the diagnosis is often made intra-operatively. Paraduodenal hernia carries a risk of incarceration leading to bowel obstruction and strangulation; therefore, it should be repaired surgically when diagnosed. Here we present a case of left PDH that was diagnosed preoperatively and repaired laparoscopically.Keywords: Laparoscopy, paraduodenal, hernia INTRODUCTIONInternal hernias result from the extension of the intestine through a defect within the peritoneum or mesentery (1). They may be either congenital or acquired. Paraduodenal hernia (PDH) is a rare congenital anomaly that results from an error of rotation of the midgut (2). PDHs are the most common form of internal hernias, accounting for 53% of all internal hernias (1, 3). PDHs are difficult to diagnose because the clinical symptoms are variable (4). PDH can begin with symptoms of acute obstruction or recurring abdominal pain (43%) or can be asymptomatic throughout the patient's life. Between 10% and 50% of internal hernias are discovered during unrelated abdominal surgeries or imaging exams and autopsy (5). Preoperative computerized tomography scan of the abdomen is usually diagnostic; however, the diagnosis is often made intra-operatively. Surgical treatment can be performed with traditional open methods or minimally invasive laparoscopic techniques. We describe herein the preoperative radiological diagnosis and successful laparoscopic repair of a left PDH in an adult man. CASE PRESENTATIONA 39-year-old man was admitted to the emergency department with complaints of epigastric cramps and nausea and vomiting that persisted for almost one day. It was known that he had been suffering from similar problems for a long time, and he had applied to 3 different hospitals in the last 10 days. There was no specific finding except for upper left quadrant tenderness. He had no history of abdominal surgery. His vital signs were normal. On his plain abdominal film, vague and limited air-fluid levels and a mass-like lesion were found in the left quadrants. Laboratory results were normal, except his leukocyte count was 11600. He was hospitalized for follow-up. It was noticed that he was comfortable while resting on his left side; however, his pain worsened in the supine position. Encapsulated and moderately dilated small bowel loops were detected in the upper left quadrant between the stomach and pancreas by CT (Figure 1). He was preoperatively diagnosed with left PDH. Four ports were inserted; one 10 mm supraumblical port for the camera, another port 10 mm from the upper left quadrant, and two 5 mm ports in the upper right quadrant. During exploration, left PDH was observed on the left side of Treitz's ligament behind the inferior mesenteric vein. An entrapped jejunum loop of approximately 80 cm was then reduced from the hernia sac into the abdominal cavity with an ...

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A rare case that caused high-level intestinal obstruction: left paraduodenal hernia

Cited by 3 publications

References 12 publications

Left paraduodenal hernia – A diagnostic challenge: Case report

Left paraduodenal hernia – A diagnostic challenge: Case report

Paraduodenal hernias: a systematic review of the literature

A case report of left paraduodenal hernia diagnosed preoperatively and treated laparoscopically

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