Left Paraduodenal Hernia Research Articles

BS SO19 - Left Paraduodenal Hernia - Laparoscopic reduction and repair

Abstract Background We present a case of a 39 year old female patient, with a BMI of 37.5 and a background of hypertension scheduled for a bariatric gastric sleeve surgery. During the surgery, incidentally, a left paraduodenal hernia was identified. The incidence of a left paraduodenal hernia is 0.03% of all hernias, which makes it a rare case to present. Method The hernia with all it contents was reduced. The defect was visualised and repaired. Haemostasis achieved. Results The postoperative period was uneventful. The patient was followed up regularly in the bariatric clinic with no further complaints. Conclusion In conclusion, this case highlights the incidental discovery and successful management of a rare left paraduodenal hernia in a 39-year-old female patient undergoing bariatric gastric sleeve surgery. Despite the rarity of this type of hernia, with an incidence of 0.03% of all hernias, prompt intervention led to a favorable outcome. The postoperative course was uneventful, and the patient reported no further complaints during regular follow-ups in the bariatric clinic. This case underscores the importance of vigilance for unexpected findings during surgery and demonstrates the successful resolution of such rare occurrences through careful surgical management.

A Case Report of Left Paraduodenal Hernia in a young boy

Internal hernia is a relatively uncommon condition and is a rare type of intestinal obstruction. Paraduodenal hernia (PDH) is the most frequent type of congenital hernia, especially on the left side. Although acute intestinal obstruction due to internal hernias is rare, it can be fatal if it is not identified and treated right away. The clinical diagnosis of paraduodenal hernia is difficult due to its rarity and variable symptoms. Here, we present the case of a 14-year-old boy who had been experiencing intermittent abdominal pain for a week duration. The pain had been worse during the previous two days, and the boy also experienced nausea and repeated vomiting episodes. He was otherwise healthy and had no history of previous abdominal operations. A left paraduodenal hernia was diagnosed based on the findings of a computed tomography scan, which showed a dilated small bowel loop occupying the left hypochondrial region anterior to the pararenal region. Due to the complicated nature of the disease, the patient had an exploratory laparotomy, during which herniated jejunal loops were reduced and hernial sac wide opened to prevent a recurrence. The patient tolerated the procedure, and recovery was uneventful. This case sheds light on the importance of considering the diagnosis of left paraduodenal hernia in patients with abdominal pain, particularly among those who have not undergone abdominal surgery previously. Early detection and treatment can prevent life-threatening complications such as intestinal perforation and peritonitis.

EP454 - Left Paraduodenal Hernia and Large Bowel Obstruction: A Case Report

Abstract Aims Internal hernias are uncommon and difficult to diagnose clinically. Of these, a paraduodenal hernia is the most common, but remains a rare condition. Cases reported in the literature are few and often describe small bowel obstruction as a result of small bowel herniation into the left paraduodenal space and lesser sac. Here we describe a case of left paraduodenal hernia resulting in large bowel obstruction. Method Written consent from the patient has been obtained to present the case and associated radiological and intra-operative images. A 50 year old male with no surgical history presented to the general surgical team via the emergency department with a 12 hour history of epigastric pain, vomiting, abdominal distension and 24 hours history of absolute constipation. CT showed a large bowel obstruction with a transition point in the mid transverse colon with a swirling of the mesentery and large bowel concerning for left paraduodenal hernia. Results Open laparotomy was the preferred approach. There was gross dilatation of the large bowel with a competent ileocaecal valve. The hepatic flexure was found herniating into the lesser sac under the ligament of Treitz. This was reduced and the large bowel decompressed via the appendix. The narrow based small bowel mesentery was expanded by dividing the mesenteric parietal peritoneum. The large defect was closed with interrupted non-absorbable sutures. The patient made an unremarkable post-operative recovery. Conclusion This is a rare pathology with interesting surgical anatomy and we present its radiological and intraoperative findings and operative management strategy.

A Rare Case of Complex Left Paraduodenal Hernia with Cocoon Abdomen

Paraduodenal hernias are rare congenital hernias that account for approximately 0.2-0.9% of all internal hernias. Among them, left paraduodenal hernias are even rarer, with an incidence of about 0.8%. Cocoon abdomen, also known as sclerosing encapsulating peritonitis, is a rare condition characterized by the encapsulation of the small bowel by a thick fibrous membrane, leading to intestinal obstruction. We present a rare case of a 45-year-old female patient who presented with complaints of left upper abdominal pain, intermittent vomiting, and abdominal distension for two months. Imaging studies revealed a complex left paraduodenal hernia with cocoon abdomen, leading to subacute intestinal obstruction. The patient underwent exploratory laparotomy, reduction of small bowel contents from the hernial sac, excision of the hernial sac, extensive adhesiolysis, and closure of the hernial defect. Intraoperatively, the entire small bowel from the duodenojejunal flexure to the ileocecal junction was encased in a thick peritoneal sac, with dense interbowel adhesions and a thick hernial sac. The postoperative course was complicated by paralytic ileus, which was managed conservatively. The patient recovered well and was discharged on a low-residue diet and appropriate medications. This case highlights the rare coexistence of a left paraduodenal hernia and cocoon abdomen, emphasizing the importance of early diagnosis and timely surgical intervention to prevent potential life-threatening complications

Don't be thrown for a loop: a review of internal hernias for the abdominal imager.

Internal hernias are herniations of abdominal viscera, usually small bowel, through congenital or acquired openings of the peritoneum or mesentery. Congenital hernias may involve anatomic fossae such as the epiploic foramen as well as those related to abnormal peritoneal or mesenteric defects; these include left and right paraduodenal, transomental, transmesenteric, pericecal and broad ligament hernias. Acquired hernias are due to defects in the mesentery or peritoneum, usually resulting from prior surgeries, and include those associated with Roux-en-Y surgery as well as colorectal cancer resections. Internal hernias account for 5.8% of small obstructions. Obstructed internal hernias are considered surgical emergencies due to the high risk of bowel strangulation. This review summarizes the various types of congenital and acquired internal hernias, their relevant anatomy, embryology, associated surgical history and imaging appearance. We will also discuss a location-based approach to identifying internal hernias on CT, as well as complications and relevant signs, of which abdominal imagers should be vigilant.

Mesocolic hernia, a case series

Introduction and importanceParaduodenal hernias are difficult to diagnose due to their unusual presentation. Herein, five new cases are added to the literature. Case presentationFour male and one female child complained of paraduodenal hernias, two on the right side and three on the left side. The intestinal part that herniated inside the hernia sac was also malrotated in four patients. One patient had Meckel's diverticulum with a herniated intestine. One infant had extrahepatic biliary disease, a single atrium, polysplenia, intestinal malrotation, and a left paraduodenal hernia. Exploratory labarotomy was done for reduction of the intestine, reorientation, and repair of hernia orifices. Clinical discussionParaduodenal hernia is a component of malrotation. Cautious dissection of the hernia orifice is required to keep away from injuries to the inferior mesenteric vein or left colic artery in the course of the restoration of the left paraduodenal hernia. Also, the superior mesenteric vessels may be injured in the course of the restoration of the right paraduodenal hernia. ConclusionThere is a correlation between the occurrence of PDH with malrotation. The diagnosis of malrotation can be made with an ultrasound abdomen; however, it is true that ultrasound cannot make a confirmed diagnosis in all patients. Once the diagnosis of a mesocolic hernia has occurred, surgical repair is mandatory by closure of the defect.

Left paraduodenal hernia: An overlooked cause of acute abdomen - A case report

Abstract Internal abdominal hernias are uncommon causes of intestinal obstruction, making them elusive in diagnosis. Paraduodenal hernias (PDH) represent the most common subset, accounting for up to 53% of all internal hernias. They occur due to herniation of the small bowel into the paraduodenal fossa. Symptomatology in a patient ranges from asymptomatic, chronic abdominal pain to acute abdomen. Although rare, a high index of suspicion of PDH is required to prevent its fatal complications such as bowel incarceration, volvulus, or strangulation. Preoperative evaluation with a computed tomography scan of the abdomen facilitates diagnosis and timely surgical intervention. We present a case of a 26-year-old male patient managed with an open surgical approach for a left PDH in an emergency with a good clinical outcome. This case report emphasizes the importance of awareness of this uncommon condition and its consideration in the differential diagnosis of acute abdomen to avert unnecessary hospitalization and surgery.

AN UNUSUAL CAUSE OF ACUTE SMALL BOWEL OBSTRUCTION

Up to 20% of admissions with severe acute abdomen are due to intestinal obstruction, a common surgical emergency. Paraduodenal hernia is a rare entity of congenital internal hernia which is an unusual cause of small bowel obstruction. This case report describes the case of a 29-year-old woman with acute pain abdomen and vomiting without other significant past history. Radiological investigations revealed mechanical bowel obstruction and gangrenous bowel loops was evident on surgical exploration. Non-viable small bowel loop was resected and peritoneal defect was sutured. Left paraduodenal hernia is a rare cause of acute abdomen and high index of suspicion is required for early diagnosis and management.

Paraduodenal Hernia (PDH ): A Rare Cause of Abdominal Pain

An internal hernia is the protrusion of a viscus through a normal or abnormal opening within the confines of the abdominal cavity. Paraduodenal hernias result from incomplete rotation of the midgut, with part of the small intestine trapped posterior to the mesocolon. Right and left paraduodenal hernias are distinct and separate entities, varying not only in anatomic structure but also in embryological origin. Symptoms are often vague, and a high index of suspicion is required to make the diagnosis. This entity should be considered whenever atypical abdominal symptoms are present. A CT scan or barium upper gastrointestinal radiography provides the best preoperative evidence of this condition, although ultrasonography and plain films are also useful. Elective repair of such a hernia should always be performed to avoid bowel incarceration or strangulation. An understanding of the anatomy of these hernias facilitates the surgery and is necessary in decreasing the likelihood of complications. Careful reduction of the hernia and surgical repair will avoid injury to the major mesenteric vessels juxtaposed to the hernial orifice. The surgical management of the patient, who were diagnosed preoperatively with this condition, is described with a review of its pathogenesis and present surgical treatment.

Congenital Left Paraduodenal Hernia: Report of a Case

Introduction. Internal hernias represent the protrusion of intestinal loops through congenital or acquired openings into the mesentery or peritoneum. One such hernia is the paraduodenal hernia, which is the most common type of internal hernia (53%). Due to the variable and non-specific clinical presentation, the preoperative diagnosis of these hernias is difficult. Despite the available studies, they generally present with intestinal occlusion, making their diagnosis during laparoscopy or laparotomy. Preoperative abdominal computed tomography facilitates diagnosis and timely surgical intervention [3]. Case presentation. This paper presents the case of a 19-year-old male patient with left paraduodenal hernia. He came to the emergency room with severe abdominal pain. Diagnosis was established by computed tomography and a converted surgical procedure was successfully performed. Discussion: Acute intestinal obstruction caused by a left paraduodenal hernia is a rare cause of intestinal obstruction. Conclusion. The patient underwent an exploratory laparotomy and it was found that the herniated intestine was viable, for which it was decided to reduce it and close the defect, obtaining good clinical results in the patient

Obstructed Left Paraduodenal Hernia with Spontaneous Reduction Demonstrated on Computed Tomography: A Case Report

Paraduodenal hernias (PDH) are the most frequently occurring internal hernia, caused due to nonfusion between inferior mesentery and parietal peritoneum. The herniation of the bowel through the fossa of Landzert results in the left paraduodenal hernia which constitutes 75% of PDH. A case of a 34-year-old male with obstructed left PDH and a spontaneous reduction is demonstrated on Computed Tomography (CT). The patient had a cluster of jejunal loops forming a sac-like mass in the left anterior pararenal space, with surrounding mass effect with twisting and stretching of the mesenteric vessels at the hernia orifice, which showed a spontaneous reduction on subsequent contrast-enhanced and delayed CT studies. Despite the imaging evidence of spontaneous reduction of left PDH in our case, surgery remains the mainstay in terms of management for left paraduodenal hernia.

Trespassing bowel: A rare case of paraduodenal hernia

Para-duodenal hernias are the most frequent type of congenital internal hernia. It is observed that left para-duodenal hernia is about three times more common than right counterpart.This case serves as an example of how bowel obstruction brought on by a paraduodenal hernia typically manifests as severe abdominal pain that worsens quickly. Considering that it is a closed loop obstruction, early bowel damage results, which explains why this illness has a high death rate. The presentation is dramatic and frequently includes peritonitis and hypovolemic shock.It is concluded that while managing a case of acute abdomen, internal hernias must always be kept in mind.

Painful Abdominal Mass Showing Internal Hernia on CT scan

We report a case of a left para-duodenal internal hernia in order to describe the role of a CT scan in its diagnosis. It was a 19-year-old boy with no known personal medical history. He was received at “The stars clinic’’ in Bamako (Mali) on 01/15/2020 for an abdominal CT scan for the assessment of diffuse abdominal pain on mass on palpation. The CT scan revealed agglutination of the small intestinal loops with its mesentery and its mesenteric vessels in the left paramedian location without complications. Faced with this semiological CT scan, the diagnosis of a left para-duodenal internal hernia was retained. Surgical management confirmed this diagnosis. Since the clinical diagnosis of an internal hernia is often unrecognized, cross-sectional imaging methods with multiplanar reformatting, in particular CT scan, remain essential in the management of this pathology.

PARADUODENAL HERNIA: A HIDDEN CULPRIT

Paraduodenal hernia is a congenital anomaly of developmental defects which occurs due to malrotation of gut in 12th week of embryonic life. This current study represents a case of left paraduodenal hernia with radiological imaging and intra-operative ndings. A 37 years old male presented in surgery OPD, RIMS, Ranchi with complains of recurrent abdominal pain on left side of abdomen since 2 months. CT Scan whole abdomen and pelvis was suggestive of left paraduodenal hernia so patient underwent pre-anaesthetic check up and exploratory laparotomy with hernia repair was done.

An unusual case of left para-duodenal hernia as a cause of recurrent intestinal obstruction-managed with laparoscopic approach

Left para-duodenal hernia (PDH) makes for around 40% of all internal hernias. It is due to the prolapse of the bowel through the fossa of Landzert, an anatomic variant that is found in around 2% of the population. This hernia is presumed to be spontaneously reducible in many patients with recurrent symptoms. The present report shows the case of this condition in a 27-year-old female presenting with recurrent abdominal pain and subacute intestinal obstruction who was managed conservatively initially. She has been operated on with a laparoscopic approach. A proper diagnosis with an immediate surgical intervention is necessary for achieving the patient’s cure and preventing complications in the future. The laparoscopic approach is usually suitable for patients with or without small bowel obstruction and hemodynamically stable.

Para-duodenal hernia: a rare case report

A para-duodenal hernia (PDH) is a rare type of internal hernia, which results from anomalous rotation and reduction of the midgut loop in the embryo. Diagnosing para-duodenal hernias can be difficult due to the wide range of symptoms that can occur. Preoperative computed tomography of the abdomen facilitates diagnosis and timely surgical intervention, which can be performed openly or laparoscopically. We here report the case of a 22-year-young male patient with a left para-duodenal hernia. He arrived in the emergency with generalized intermittent crampy abdominal pain, associated with nausea and obstipation. An abdominal computed tomography (CT) revealed that he had a left PDH, which was effectively treated with open surgical repair. Clinical presentation of para-duodenal hernia ranges from asymptomatic to manifest. The greatest difficulty regarding the management of para-duodenal hernias lies in their diagnosis. Many studies have shown that the best option for diagnosis is computed tomography (CT). Open and laparoscopic techniques are used in the treatment of para-duodenal hernias with similar results. We report our experience in the management of left para-duodenal hernia. The case of a 22-year-old male patient with LPDH with non-specific symptomatology was presented. CT scan is the best diagnostic option for this condition. The open surgical approach was used with great success.

MANAGEMENT OF LEFT PARADUODENAL HERNIA - A CASE REPORT

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

Concomitant ileocecal intussusception due to cecal lipoma and paraduodenal hernia

We present a healthy adolescent male with no past surgical history who presented with acute onset abdominal pain. Cross-sectional imaging was concerning for possible ileocecal intussusception, and repeat imaging demonstrated an internal hernia. The patient was taken to the operating room for exploration. He was discovered to have an ileocecal intussusception with a large cecal mass, as well as a left paraduodenal hernia. Closure of the mesenteric defect and ileocecectomy with primary anastomosis were performed. Pathology of the mass was consistent with colonic lipoma. Postoperatively, he had slow return of bowel function, but his recovery was otherwise uncomplicated. This case reports a rare presentation of concomitant ileocecal intussusception due to a cecal lipoma and congenital internal hernia. Intussusception in the pediatric population is typically idiopathic, and intussusception with a pathologic lead point is far more common in adults. Gastrointestinal lipomas are also uncommon in pediatric patients, and when discovered are generally small and asymptomatic. Internal hernias most commonly are due to acquired mesenteric defects or adhesive disease, though may present congenitally as seen in this patient. This case is unique because of the simultaneous occurrence of two separate surgical problems, both with atypical etiologies based on patient history and demographics.

A Left Paraduodenal Hernia: an “Incidental Finding” in a Virgin Abdomen with Small Bowel Obstruction

BackgroundA left paraduodenal hernia is a rare clinical condition, resulting from embryological abnormalities or anomalies of the peritoneal attachments. Preoperative diagnosis is difficult because of its nonspecific clinical manifestations. Presentation of a CaseA 42-year-old man, with negative surgical history, presented to the emergency department with complaints of severe acute epigastric pain and vomiting of 12 h duration. The patient did not report any episodes of abdominal pain in his history. Computed tomography imaging was suggestive for a closed-loop obstruction. An emergency laparoscopy was performed, revealing a pathologically dilated tangle of jejunal loops and an incidental finding of a left paraduodenal hernia, the latter containing small bowel loops with normal caliber. The small bowel loops were reduced, and the hernia orifice was closed via non-absorbable sutures to restore normal anatomy. The pathologically dilated small bowel segment with serosal scar tissue, probably developed secondary to a previous episode of incarceration, was resected. ResultsA high level of clinical suspicion for a left paraduodenal hernia is advocated in patients with a virgin abdomen, presenting with recurrent vague abdominal pain or acute symptoms of small bowel obstruction. Usually, a left paraduodenal hernia is an incidental finding on computed tomography imaging or during diagnostic laparoscopy. Surgical repair is the mainstay therapy, even in asymptomatic cases, to prevent future small bowel incarceration which develops in almost half of the cases. The laparoscopic approach is feasible and safe, also in an emergency setting. ConclusionsBy presenting this case, we assume to raise awareness as many clinicians are unfamiliar with this rare condition. Clinical suspicion and detailed knowledge of the etiology, anatomy, and vascular landmarks allow surgeons to accurately manage a left paraduodenal hernia.

Left Para duodenal Hernia: Case Report of Rare Cause of Small Bowel Obstruction

Para duodenal hernia [PDH], a rare congenital anomaly, is a type of internal hernia which occurs due to a defect in the reduction and rotation of the midgut. We present the case of a 32-year-old female patient presented with a seven-day history of generalized intermittent colicky abdominal pain accompanied by multiple episodes of bilious vomiting. She was otherwise healthy and had no history of previous abdominal operations. Computed tomography scan of the abdomen demonstrated sac-like clustered small bowel loops noted in the left upper quadrant, in the anterior para-renal space, consistent with the diagnosis of left Para duodenal hernia. Exploratory Laparotomy for the repair of the hernia was planned. The jejunal loops had herniated through the fossa of Waldeyer. Reduction of hernia contents and excision of the hernia sac was carried out. The patient tolerated the procedure without complications, and she was asymptomatic in the follow-up visit. This case sheds light on the importance of considering the diagnosis of left Para duodenal hernia in patients with recurrent abdominal pain, particularly among those who have not undergone abdominal surgery previously.