Laparoscopic repair of a right-sided paraduodenal hernia

Abstract

With an incidence of less than 1%, paraduodenal hernias are very rare but account for ~0.2–5.8% of mechanical small bowel obstruction and carry a mortality rate of 20–50%. Right-sided paraduodenal hernias are three times less frequent than left-sided paraduodenal hernias. We report the case of a 37-year-old man who suffered from colicky abdominal pain accompanied by vomiting. The computed tomography scan showed a mechanical ileus, caused by a presumed paraduodenal hernia, and we chose an elective laparoscopic surgical approach. The patient recovered quickly and was discharged on the second postoperative day. Paraduodenal hernias are a diagnostic challenge as they are typically characterized by long-term non-specific abdominal symptoms and are only detected in the event of acute intestinal obstruction. Until now, laparoscopic therapy has only been described in eight case reports and we review this rare condition and the surgical options.

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

“…A right PDH develops from embryonic anomalies of the peritoneum and is associated with abnormal intestinal malrotation [ 3 , 6 , 5 ]. Bill et al.…”

“…PDHs occur due to incomplete rotation and fixation abnormalities of the primitive midgut during fetal development [ 1 , 3 ]. PDH with strangulation is associated with high mortality rates (20%–50%) [ 4 , 5 ]. Although prompt diagnosis and surgical treatment are essential, PDHs occasionally are a diagnostic difficulty owing to the rarity [ 5 ].…”

“…PDH with strangulation is associated with high mortality rates (20%–50%) [ 4 , 5 ]. Although prompt diagnosis and surgical treatment are essential, PDHs occasionally are a diagnostic difficulty owing to the rarity [ 5 ]. In cases of right PDHs with malrotation, strangulation of the intestinal tract may occur both inside and outside the hernial sac.…”

Reduced‐port surgery for right paraduodenal hernia in an adult patient: A case report and review of the literature

“…However, but there is no definite indication about which option is preferable. In Table 1, we summarize seven previously reported cases of laparoscopic repair for right PDH in adult patients 2‐8 . In cases with a small hernial orifice, closing the hernial orifice is a simple treatment option.…”

Less invasive treatment for broad ligament hernia: A case report

“…The main causes of internal hernia are paraduodenal hernia (53%), pericecal hernia (13%), foramen of Winslow hernia (8%), and transmesenteric and transmesocolic hernia (6%) [ 9 ], all of which have been reported to be possibly treated by laparoscopic surgery [ [10] , [11] , [12] , [13] ]. If a working space can be secured by decompressing the intestine, reduced port surgery may be selected, leading to a less invasive surgery.…”