Clinical importance of duodenal recesses with special reference to internal hernias

Abstract

IntroductionThe detailed knowledge of the peritoneal recesses has great significance with respect to internal hernias. The recesses are usually related to rotation and adhesion of abdominal viscera to the posterior abdominal wall and/or the presence of retroperitoneal vessels which raises the serosal fold. The duodenal recesses are usually related to the 3rd and 4th parts of the duodenum. Internal hernias with respect to these recesses are difficult to diagnose clinically and usually noticed at the time of laparotomy. So, the knowledge of these recesses can be valuable to abdominal surgeons.Material and methodsThe present study was conducted in 100 cases including 10 cadavers, 45 post mortem cases and 45 cases undergoing laparotomy.ResultsWe found superior and inferior duodenal recesses in 28% and 52% respectively, paraduodenal in 12%, mesentericoparietal in 3%, retroduodenal in 2% and duodenojejunal in 18% of cases. Two abnormal duodenojejunal recesses were found, one on the right (instead of the left) of the abdominal aorta, and in the other the opening was directed upwards instead of downwards. The incidence of internal hernias was 3%.ConclusionsThus it was observed that there is low incidence of superior and inferior duodenal recesses, and high incidence of paraduodenal recess. The abnormal recesses might be due to malrotation of the gut. In laparotomy cases, the internal hernia was noticed when the abdomen was opened for intestinal obstruction. The incidence of internal hernia was found to be high.

A paraduodenal hernia revealed by bowel obstruction: case report and literature review

“…At autopsy, the Landzert’s fossa was found in about 2% of the population [9, 10]. However, in a recent study paraduodenal recess was found in 12% of cases [12].…”

Treitz Hernia: Report of a Case and Review of the Literature

“…This type of congenital recess is present in 40% to 50% of autopsies and usually coexists with the inferior duodenal fossa. 3,6,7 The inferior duodenal fossa alone is the most common finding (60%), whereas, in 15% to 20% of cases, both recesses are replaced by the duodenojejunal fossa, which is flanked above by the pancreas, to the right by the aorta, and to the left by the kidney, with the left renal vein below. 6 Another left-sided peritoneal fold in this area is the paraduodenal Lanzert's fossa (also called Recessus paraduodenalis, found in 2% of autopsies).…”

Identification and Repair of Left-Sided Paraduodenal Hernia Using Both Laparoscopic and Robotic Techniques

“…Symptoms of PDH are often nonspecific, intermittent, and encompass many acute and chronic obstructive-type abdominal complaints. Patients can be entirely asymptomatic or describe symptoms ranging from intermittent abdominal pain due to spontaneous hernia reduction [8] to an acute abdomen with associated strangulation and bowel necrosis. Only 50% of patients recall previous nonspecific recurrent abdominal pain [9], typically worse after meals and improved with body position [5].…”