Atypical left paraduodenal hernia

Abstract

A 47-year-old man came to the hospital because acute abdominal pain and vomits. The patient had suffered from episodes of intestinal obstruction since adolescence, and has been studied by a gastroenterologist who found no abnormalities. These episodes have been solved spontaneously in nearly all occasions. However, he had come to the emergency room for the same reason twice last year. The exploration showed abdominal distension and tympanism in the epigastrium. There were neither laparotomic scars nor hernia defects in the abdominal wall. Abdominal X-rays showed air-fluid levels at the small bowel, and marked distension in the proximal and medium jejunum. Gastrointestinal X-ray series with gastrographin showed no abnormal findings. After 48-72 hours the patient persisted with the same complaints, and we decided to operate. During the operation we found a congenital malformation: an intestinal hernia of jejunum inside a peritoneal sac formed by a peritoneal flap of the left mesentery (Fig. 1), as well as an abnormal implantation of the mesentery above the rectum. We performed a resection of the peritoneal sac (Fig. 2) and the adherences inside it. The postoperative period was normal. DISCUSSIONParaduodenal hernias are rare congenital malformations, but they are the most frequent cause of internal hernias (50% of them). They are caused by a failure in the intestinal rotation, and by an asynchronism in the future development of adhesion of the mesocolon. In right paraduodenal hernias, the small bowel is placed totally or partially behind the ascending mesocolon; in left paraduodenal hernias or mesocolic hernias, which are more frequent than the right ones, the small bowel is placed behind the descending mesocolon (1). We present a rare case of a paraduodenal sac formed by a peritoneal

Laparoscopic repair of the left paraduodenal hernia: A rare case of an internal hernia

“…[ 13 ] Early surgical intervention is essential because the mortality rate is 20–50% for acute intestinal ischemia in PDH patients. [ 14 , 15 ]…”

An uncommon cause of acute bowel obstruction: The left para-duodenal hernia

“…About 10% to 15% of cases are discovered preoperatively. [6] Often, the clinical signs are dominated by periombilical cramps or postprandial epigastric pain, nausea, vomiting and so rarely the presence of an abdominal mass in the left side of the abdomen. But the most common presentation of left PH is acute small bowel obstruction.…”

Left Paraduodenal Hernia Presenting with Atypical Symptoms

“…They are defined as herniation of a viscus through an intraperitoneal orifice or aperture within the confines of the peritoneal cavity 1. Paraduodenal hernias, although rare in clinical practice, represent the most common type of congenital internal hernia 1-7. Presentation can range from acute intestinal obstruction (the most common clinical presentation) to an extended history of vague abdominal pain, often relived by changes in position 2,5,8.…”