Acute intestinal obstruction secondary to left paraduodenal hernia: a case report and literature review

Abstract

IntroductionAn internal hernia is a protrusion of bowel through a normal or abnormal orifice in the peritoneum or mesentery. Although they are considered as a rare cause of intestinal obstruction, paraduodenal hernias are the most common type of congenital hernias.MethodsA literature search using PubMed was performed to identify all published cases of left paraduodenal hernia (LPDH).ResultsIn Literature search between 1980 and 2012 using PubMed revealed only 44 case reports before the present one. Median age was 47 years (range 18 – 82 years). Nearly 50% reported previous mild symptoms. Two-third of patients required emergency surgery in form of laparotomy or laparoscopic repair. Reduction of hernia contents with widening or suture repair of the hernia orifice were the most common standards in surgical management of LPDH.ConclusionIntestinal obstruction secondary to internal hernias is a rare presentation. High index of suspicion and preoperative imaging are essential to make an early diagnosis in order to improve outcome.

Acute intestinal obstruction secondary to left paraduodenal hernia: a case report

“…[8] However, CT is emerging as the most effective method for the diagnosis of paraduodenal hernia. [6] Encapsulated clustering of bowel loops at the duodenojejunal junction between the stomach and the pancreas to the left of the ligament of Treitz or behind the pancreatic tail itself and the left displacement of the inferior mesenteric vein are the major descriptive imaging features. Depression of duodenojejunal junction causing dilatation and air-fluid levels in the trapped loops, and the engorgement and crowding of the mesenteric vessels are characteristic features.…”

“…Landzert's fossa is a hole through the mesocolon of the transverse colon located behind the ascending or fourth segment of the duodenum formed by the lifting of the peritoneal fold by the inferior mesenteric vein and ascending left colic artery running along the lateral fossa. [1,6] The most common presentation of internal herniation is acute small bowel obstruction with pain on the left upper segment of the abdomen, distention, nausea, vomiting, and obstipation. Some patients may experience recurrent symptomatic episodes that are often postprandial and relieved in the supine position.…”

Hernia transmesentérica. Revisión del tema a raíz de un caso exótico de infarto intestinal en un adulto

“…El intestino protruido se aloja en la fosa de Landzert (29,30). El total de casos de HP reportados hasta el año 2012 era de solo 44 (31,32).…”

A Rare Etiology of Intestinal Obstruction: Paraduodenal Hernia

“…It may lead to intestinal obstruction or is typically detected incidentally at autopsy or laparotomy. They are divided into distinct subgroups based on the localization: the paraduodenal area is the most common type with an overall incidence of 53%, followed by pericecal (13%), foramen of Winslow and transmesenteric (8%), intersigmoid, supravesical and pelvic (6%), and transomental (1-4%) localizations [1][2][3]. There are two types of congenital paraduodenal hernia: leftsided, which is more common (75%), and right-sided, which is very rare (25%) [4].…”

“…There are two types of congenital paraduodenal hernia: leftsided, which is more common (75%), and right-sided, which is very rare (25%) [4]. There is a sex predilection with a male to female ratio of 3:1 [2,5]. The reported lifetime risk of obstruction and bowel strangulation is around 50% with a mortality of 20% and higher [4,6].…”