A paraduodenal hernia revealed by bowel obstruction: case report and literature review

Abstract

Internal hernias are defined as the protrusion of abdominal viscera through an aperture in the intraperitoneal recesses, they are considered as a rare cause of intestinal obstruction. The paraduodenal hernias are the most common type of congenital hernia especially the left-sided ones. We report a case of a 46 year-old man presenting a left paraduodenal hernia with acute small bowel obstruction, which was firstly (preoperatively) assigned to a tumoral cause.

Paraduodenal hernias in children: Etiology, treatment, and outcomes of a rare but real cause of bowel obstruction

“…PDH is of congenital origin and formed by the herniation of small bowel through a congenital defect. This congenital defect is a potential space behind the mesocolon, formed as a consequence of fusion failure of the mesocolon with the parietal peritoneum [6].…”

“…Almost half of the PDH patients are asymptomatic and the other half can present with recurrent upper abdominal pain (43%) [6], symptoms of partial or complete small bowel obstruction or mesenteric vascular compromise [10]. However, 69% of the symptomatic cases present with chronic symptoms of around 1.8 years duration preceding the obstruction or strangulation symptoms.…”

“…Nonspecific findings can be found during physical examination, including abdominal distension and tenderness [3]. In addition, left paraduodenal hernia can lead to the appearance of a palpable abdominal mass in the left upper quadrant only in one third of cases [6].…”

“…Therefore, the pre-operative diagnosis of asymptomatic PDH resembles a diagnostic challenge. Whenever symptoms develop, diagnosis made easier for clinician [6]. Plain x ray is the first line radiological exam in the emergency department which may reveal the PDH as a cluster of small bowel loop in the right or left upper quadrants with signs of small bowel obstruction [4].…”

Paraduodenal Hernia- An Obscure and Perilous Cause of Intestinal Obstruction.

“…Left sided PDH is more common, generally occurs in male and has50% life time risk of developing small bowel obstruction with 20-50% mortality [2].…”