Right paraduodenal hernia in an adult patient: emergency management

Adriá Rosat,Manuel Barrera,Victor Vázquez ,Ana María Feria ,M.a Varona

doi:10.11604/pamj.2016.23.240.8104

Adriá Rosat, Manuel Barrera + Show 3 more

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https://doi.org/10.11604/pamj.2016.23.240.8104

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Abstract

We report a case of right paraduodenal hernia in an adult patient and its emergency diagnosis and management in an acute clinical presentation. A twenty-eight-year-old male patient was admitted in our outside hospital's emergency room after 12 hours of evolution of diffuse abdominal pain, nausea and vomiting. He referred a similar episode several months ago that ceased spontaneously. An abdominal CT scan with intravenous contrast demonstrated an encapsulated cluster of small bowel loops occupying mainly the right upper quadrant, lateral to the duodenum, suspicious for an internal hernia in the context of an intestinal malrotation. The patient underwent a laparotomy, which revealed a large sac containing dilated small bowel loops as shown by radiologic studies. The patient did well in postoperatory and was discharged home on the fourth day after the surgery. In a year follow up the patient remained asymptomatic.

Highlights

IntroductionThe first definition of a right paraduodenal hernia was proposed by Moynihan in 1906 and included the following criteria: most of the small bowel is trapped within a peritoneal sac between the right and transverse colon and is positioned right of midline, the hernia sac opens to the left at the ligament of Treitz, and either the superior mesenteric or ileocolic artery is found at the anterior aspect of the sac [1]
We report a case of right paraduodenal hernia in an adult patient and its emergency diagnosis and management in an acute clinical presentation
The first definition of a right paraduodenal hernia was proposed by Moynihan in 1906 and included the following criteria: most of the small bowel is trapped within a peritoneal sac between the right and transverse colon and is positioned right of midline, the hernia sac opens to the left at the ligament of Treitz, and either the superior mesenteric or ileocolic artery is found at the anterior aspect of the sac [1]

Summary

Introduction

The first definition of a right paraduodenal hernia was proposed by Moynihan in 1906 and included the following criteria: most of the small bowel is trapped within a peritoneal sac between the right and transverse colon and is positioned right of midline, the hernia sac opens to the left at the ligament of Treitz, and either the superior mesenteric or ileocolic artery is found at the anterior aspect of the sac [1]. The most common presentation is acute small bowel obstruction, with crampy abdominal pain, nausea, vomiting and distension. The patient may complain of vague and chronic abdominal pain or periodic distension, which results from partial obstruction. These nonspecific symptoms are often incorrectly attributed to biliary disease, gastritis, or gastroesophageal reflux. A paraduodenal hernia may be discovered incidentally at autopsy [2, 5] In many cases it causes no symptoms and diagnosis may be made when a barium x-ray examination shows the small bowel either to the right or left of the midline in the abdomen [2]. We report a case of right paraduodenal hernia in an adult patient and its emergency diagnosis and management in an acute clinical presentation.

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