Left paraduodenal hernia: a rare cause of small bowel obstruction in the elderly

Abstract

Left paraduodenal hernia is a rarely found condition in which the small bowel herniates through a congenital peritoneal defect located behind the 4th portion of duodenum. It usually courses with non-specific symptoms and a widely variable clinical presentation which makes preoperative diagnosis very difficult. It has been associated with a high rate of complications, including bowel strangulation and even death. Prompt surgical intervention consisting of intraoperative surgeon's awareness and recognition of this condition are crucial in order to improve postoperative morbidity and mortality. The authors present a case of a 73-year-old man with acute intestinal obstruction as the first presentation of a left paraduodenal hernia.

Left Paraduodenal Hernia: A Rare Complication following Laparoscopic Appendectomy

“…Approximately 50% of patients recall previous recurring abdominal pain of nonspecific nature [ 9 ]. As such, the entity poses a diagnostic challenge, with majority of cases identified only at operation [ 10 ]. Patients with LPDH have a 50% lifetime risk of hernia incarceration with 20–50% mortality for acute presentations; hence, operative management is recommended regardless of symptoms [ 5 ].…”

Large left paraduodenal hernia with intestinal ischemia: a case report and literature review

“…However, laparoscopy also has a risk of iatrogenic injury, including rupture of the small intestine due to incarcerated intestinal dilatation, abdominal congestion, and massive exudation. 12,28 In summary, the incidence and preoperative diagnosis rate of LPDH are low, and the timing of the operation is very important. We hope that through this case report, the possibility of this disease will be considered in patients who develop intestinal obstruction without a history of surgery.…”

“…However, laparoscopy also has a risk of iatrogenic injury, including rupture of the small intestine due to incarcerated intestinal dilatation, abdominal congestion, and massive exudation. 12 , 28 …”

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

“…The Landzert fossa is an unusual peritoneal defect, present in 2% of the population, and located lateral to the fourth part of the duodenum, posterior to the IMV and the ascending branch of the ascending left colic artery (LCA) [ 2 , 11 , 16 ]. It also extends behind the descending mesocolon [ 2 , 11 , 16 – 19 ]. This anatomical region is the crossroad between the descending mesocolon, transverse mesocolon, and small bowel mesentery [ 11 , 17 , 18 ].…”