MANAGEMENT OF LEFT PARADUODENAL HERNIA - A CASE REPORT

Abstract

Paraduodenal hernias are rare type of internal hernias also known as Treitz hernia or Mesocolic hernia that occur due to congenital anomaly in rotation of the midgut. The anomaly is either malrotation of midgut or failure of mesentery of ascending colon to fuse with parietal peritoneum. The presenting symptoms can range from mild abdomen pain to small bowel obstruction and gangrene. The hernias can be left or right sided depending upon their relationship with the mesenteric vessels of small bowel. Internal hernias, including paraduodenal hernia (the most common), periceacal, foramen of Winslow and inter sigmoid hernias, account for approximately 0.5 to 5.8% of all cases of intestinal obstruction and are associated with high mortality rate. We present a case of left paraduodenal hernia occurring in 40yr old male patient who presented with complaints of mass and pain in left side of abdomen for 1 week. CT imaging was done which showed clusters of dilated bowel segments with displaced mesenteric vessels at hernial orice. After evaluation diagnosed as left paraduodenal hernia and through laparoscopy bowel loops decompressed from the fossa of Landzert and hernial sac repair done. Post operative period was uneventful and was discharged after 3 days. Paraduodenal hernias are rare causes of small bowel obstruction which can be difcult to diagnose clinically and require cross sectional imaging for diagnosis. These hernias occur due to congenital anomaly of malrotation of the small bowel and fusion of mesentery. Surgical correction is done electively or on emergent basis with open or laparoscopic technique depending upon the clinical scenario and availability of laparoscopy