Mesocolic Hernia Research Articles

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.

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

Intestinal Malrotation, Mesocolic Hernia, and Meckel Diverticulum – Differential Diagnosis of Abdominal Pain in Adults: Case Report and Literature Review

AbstractIntestinal malrotation is a congenital anomaly caused by incomplete rotation or absence of rotation of the primitive intestine along the axis of the upper mesenteric artery during embryonic development. Embryonic development and its anatomical variations were described by Dott in 1923.Intestinal malrotation is a rare condition among adults – prevalent in a mere 0.0001% to 0.19% of the population –, and it may be associated with other anatomical deformities. It can be asymptomatic or manifest with varying intensity, from obstruction to necrosis of intestinal segments. In general, this abnormality is diagnosed in the first year of life; however, symptoms may appear later in life, making diagnosis in adults difficult on account of non-specific symptoms.In the present study, we report a case of intestinal malrotation associated with chronic non-specific symptoms progressing to mesenteric angina.

Mesocolic hernia: unusual cause of intestinal obstruction in children

Mesocolic hernia: unusual cause of intestinal obstruction in children

The Rare Middle Mesocolic Hernia.

The Rare Middle Mesocolic Hernia.

PARADUODENAL HERNIA- AN OBSCURE AND PERILOUS CAUSE OF INTESTINAL OBSTRUCTION.

Paraduodenal hernias (PDH) constitute more than half of internal hernias. Both left and right PDH occur due to error of rotation of gut and defective fusion of mesocolon and mesentery with posterior parietal peritoneum. Clinical diagnosis of PDH is very difficult because of its varied presentation and nonspecific symptoms. Prompt diagnosis and surgery is imperative to avoid strangulation of bowel which is associated with high mortality. Before the advent of CECT many were discovered during exploratory laparotomy or unrelated abdominal surgery. Now CECT abdomen has become the gold standard for pre-operative diagnosis of PDH. We report two cases of PDH, one on left side and another on right side, diagnosed preoperatively and treated successfully.
 Keywords: Paraduodenal hernia, Mesocolic hernia, Treitz hernia, Internal hernia

Paraduodenal hernias: a systematic review of the literature.

Paraduodenal hernias (PDH), also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0.2-0.9% of all cases of intestinal obstruction. This is the first systematic review of all reported cases so far, investigating their clinical presentation, radiological imaging, and treatment outcomes. After a detailed search in PubMed and Medline, using the keywords "paraduodenal hernia", 115 studies matched our criteria. A review of these reports was conducted and the full texts were examined. A total of 159 patients were included in our analysis, with 69.8% and 30.2% of them suffering from either a left or a right PDH, respectively. Mean age at diagnosis was 44.1years, with a 2/1 male/female ratio. PDH were associated with non-specific symptoms and signs; abdominal pain being the most common. Computed tomography (CT) scan of the abdomen was the most frequently used diagnostic modality. Regardless of PDH localization, all patients were operated on, with approximately one-third of them undergoing a laparoscopic operation, which was associated with a significantly decreased morbidity rate as well as length of hospital stay, compared with the open repair. PDH are not usually associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of knowledge and clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair, seeming to be the optimum treatment strategy.

Left-sided mesocolic hernia presenting as internal Maydl's hernia, complicated by jejunal volvulus

Left mesocolic hernia (syn – left paraduodenal hernia/hernia of Landzert) is a type of internal hernia which occurs due to malrotation of the midgut and forms a potential space near the ligament of trietz. Prompt diagnosis is crucial to prevent strangulation. We report a rare case of left mesocolic hernia presenting as internal Maydl's hernia complicated by jejunal volulus, presenting as acute abdomen. An emergency derotation and reduction of small bowel was done with repair of the defect.

Strangulation of the small intestine caused by an intra-mesosigmoid hernia: a case report

Sigmoid mesocolon hernia is an uncommon type of internal hernia with only a few cases reported to date. This disease entity can progress rapidly to cause vascular disturbance, necrosis, and perforation of the bowel wall; therefore, early diagnosis and surgical treatment are essential. We describe the case of an intra-mesosigmoid hernia in a 60-year-old man without history of previous abdominal surgery who presented with sudden acute abdominal pain and vomiting. Based on computed tomography, which showed ascites and small bowel obstruction, we diagnosed him as having strangulation of the small intestine caused by a sigmoid mesocolic hernia and performed emergency surgery. Laparotomy revealed small intestinal strangulation, extensive engorgement, and discoloration of bowel loops. Approximately 100 cm of the small intestine extending from the ligament of Treitz had undergone strangulation and herniated into the defect of sigmoid mesocolon, leading to a diagnosis of an intra-mesosigmoid hernia. Because the incarcerated portion of the small intestine was viable, we did not perform intestinal resection and reconstruction but closed the defect in the sigmoid mesocolon. His postoperative course was uneventful.

Malrotation with Isomerism: Laparoscopic Ladd Procedure

Introduction: Isomerism is a rare congenital condition in which one side of the body is a mirror image of the opposite side of the body. Abdominal manifestations include abnormal stomach positioning with possible malrotation of the intestines.1 If malrotation occurs, a laparoscopic Ladd procedure is performed. Materials and Methods: This video shows a laparoscopic Ladd procedure done in a 9-month-old male with right-sided isomerism and asymptomatic intestinal malrotation. Access to the right lower quadrant was achieved by a modified Hasson technique with a Step™ trocar (Auto-Suture) placed through a 5 mm incision in the umbilicus. Pneumoperitoneum was established using 5 L/minute of carbon dioxide under 12 mm Hg of pressure. A 30° telescope camera was inserted into the peritoneal cavity for proper observation. Next, two 3 mm incisions were made in the lower right and left abdominal quadrants. A 3 mm port was placed on the right and a 5 mm port was placed on the left with Step trocars (Auto-Suture). Important structures were immediately identified. The liver was located in the center of the abdomen and the spleen was absent, suggestive of right-sided isomerism. The attachment between the splenic flexure of the colon and the left lateral abdominal wall was divided. The colon was then reflected downwards, exposing the centrally located stomach. Duodenal loops were released from the Ladd bands, allowing for observation of the pancreas lying inside of the C-loop of the duodenum. While looking for the distal portion of the jejunum, it was discovered that the entire jejunum was trapped retroperitoneally, creating a mesocolic hernia. Using hook diathermy, the entire bowel was released down to the ileocecal region, which was in its normal anatomical location in the right lower quadrant. The appendix appeared normal. Using hook diathermy, the mesentery of the appendix was taken down. The appendix was ligated with two 3′0 Vicryl ties, resected, and removed through a port site. All of the small bowel was placed on the right side of the abdomen, and all of the large bowel was placed on the left. Finally, the stomach was insufflated to rule out an intrinsic duodenal obstruction. Air passed easily into the stomach and across the duodenum, confirming patency. The bowel appeared completely viable. Ports were withdrawn after desufflating the pneumoperitoneum. The umbilical port site was closed with 2-0 Vicryl UR-6 single suture. All other port sites were closed with Dermabond glue. Results and Conclusions: There were no postoperative complications. The patient began tolerating feeds on post-operative day #3 and was discharged on post-operative day #4. No competing financial interests exist. Runtime of video: 5 mins 51 secs

Congenital middle mesocolic hernia – An unusual cause of small bowel obstruction

Internal herniation is a rare cause of small bowel obstruction, with an incidence of 0.2-0.9%. Obstruction due to congenital internal hernias is even rarer. The commonest type of congenital internal hernia is the paraduodenal or the mesocolic hernia. The left and right mesocolic hernias constitute 75% and 25% of the mesocolic hernias respectively. Middle mesocolic hernias are an extremely rare and unusual variant of mesocolic hernia, and literature search revealed only three reported cases. In view of its rarity, a high level of clinical suspicion, supported by radiological evidence is required to diagnose it preoperatively. Prompt surgical management is mandatory to reduce complications and their associated morbidity and mortality.

Mesocolic Hernia: The Achilles Heel of the Retrocolic Gastric Bypass

Mesocolic Hernia: The Achilles Heel of the Retrocolic Gastric Bypass

Laparoscopic Repair of Internal Transmesocolic Hernia of Transverse Colon.

Introduction. Internal hernias are often misdiagnosed because of their rarity, with subsequent significant morbidity. Case Presentation. A 61-year-old Japanese man with no history of surgery was referred for intermittent abdominal pain. CT suggested the presence of a transmesocolic internal hernia. The patient underwent a surgical procedure and was diagnosed with transmesocolic internal hernia. We found internal herniation of the small intestine loop through a defect in the transverse mesocolon, without any strangulation of the small intestine. We were able to complete the operation laparoscopically. The patient's postoperative course was uneventful and the patient was discharged on postoperative day 6. Discussion. Transmesocolic hernia of the transverse colon is very rare. Transmesocolic hernia of the sigmoid colon accounts for 60% of all other mesocolic hernias. Paraduodenal hernias are difficult to distinguish from internal mesocolic transverse hernias. We can rule out paraduodenal hernias with CT. Conclusion. The patient underwent a surgical procedure and was diagnosed with transmesocolic internal hernia. We report a case of a transmesocolic hernia of the transverse colon with intestinal obstruction that was diagnosed preoperatively and for which laparoscopic surgery was performed.

A Case of Sigmoid Mesocolic Hernia

A Case of Sigmoid Mesocolic Hernia

OC-127 One thousand laparoscopic ROUX-EN-Y gastric bypasses: perioperative and long term outcomes

IntroductionLaparoscopic Roux-en-y gastric bypass (LRYGB) has been established as an effective treatment for obesity and obesity related morbidity. However, safety of LRYGB remains under public scrutiny. Defining operative outcomes is...

Laparoscopic management of small bowel obstruction caused by a Sigmoid Mesocolic hernia

Internal hernias involve protrusion of viscera through the peritoneum or mesentery into a compartment in the abdominal cavity. Hernias occurring through the meso-sigmoid are rare and the most common presentation of this entity is an acute small intestinal obstruction. Pre-operative diagnosis is often difficult and the diagnosis is usually made at surgery. Traditionally, open surgery is used to manage a meso-sigmoid hernia. We report a patient with meso-sigmoid hernia causing intestinal obstruction managed successfully by the laparoscopic approach.

Congenital and acquired mesocolic hernias presenting with small bowel obstruction in childhood and adolescence

Congenital and acquired mesocolic hernias presenting with small bowel obstruction in childhood and adolescence

Left paramesocolic hernia presenting as post appendicectomy abdominal cocoon

We describe a rare case of left mesocolic hernia presenting as post appendicectomy intestinal obstruction in a girl. Laparotomy confirmed partial peritoneal encapsulation of upper small bowel due to herniation of jejunal loops into the left mesocolic hernia sac. Reduction of contents, resection of the sac and repair of the defect concluded the procedure uneventfully.

Congenital and acquired mesocolic hernias presenting with small bowel obstruction in childhood and adolescence

Objective The objective was to present a case series of pediatric patients presenting with small bowel obstruction secondary to both congenital and acquired internal mesocolic hernias, and the use of imaging technology in the management of this condition. Methods A retrospective review of patients treated at the Yale–New Haven Children's Hospital for small bowel obstruction from 1998 to 2008 (n = 6) who presented with acute small bowel obstruction secondary to internal mesocolic hernias was performed. Results We present 6 patients with small bowel obstruction caused by congenital (n = 4) and acquired (n = 2) mesocolic hernias after previous surgery. The median age at presentation was 13 years. Small bowel obstruction with a mesocolic hernia was identified by preoperative abdominal computerized tomography in 3 patients (50%) and at operation in the others. The mean length of stay was 6 days, with no recurrent episodes in the follow-up period. Conclusion Small bowel obstruction secondary to mesocolic hernias, although rare, may be considered in the differential diagnosis of patients with history of malrotation or abdominal wall defects owing to their association with congenital mesenteric anomalies. This condition requires special attention from the clinician because of its catastrophic consequences. Imaging studies are an important asset because of the difficulty in making an accurate clinical diagnosis and the rarity of internal hernias.

An unusual case of congenital mesocolic hernia

An internal hernia is defined as the herniation of viscera through an anatomic or pathologic opening within the confines of the peritoneal cavity. This herniation may be persistent or intermittent. Because of the risk of strangulation of the hernia contents, even small internal hernias are dangerous and may be lethal. Preoperative misdiagnosis has been reported to be elevated. Here, we report and discuss the clinical appearance and treatment approach of an unusual case of a spontaneous left paraduodenal hernia occurred in a child.