Diagnosis and treatment of symptomatic right paraduodenal hernia: report of a case

Abstract

We report a typical case of right paraduodenal hernia (RPH) and review the literature on the pathogenesis, diagnosis and treatment of this uncommon entity. A 32-year-old woman was hospitalized with acute abdominal cramps, nausea, and vomiting. Computed tomography (CT) findings suggested RPH, which was confirmed by explorative laparoscopy. We performed an open repair by suturing the orifice after reducing the hernia. At her 2-year follow-up, the patient reported complete resolution of her symptoms. Because RPH is rare and its clinical signs are nonspecific, radiological examinations are essential for a correct preoperative diagnosis. CT is currently the most accurate diagnostic tool, but laparoscopy may be necessary to confirm the diagnosis. This hernia can be repaired by simple suturing of the hernial orifice, either laparoscopically or via an open procedure, although several authors consider complete intestinal derotation to be the best option.

Intestinal obstruction secondary to left paraduodenal hernia

“…LPDHs have been referred to by various terms: Treitz retroperitoneal hernia, hernia of the fossa of Landzert, mesentericoparietal hernia of Logace and hernia into the descending mesocolon of Callader [ 6 ]. Overall, a LPDH is three times more common than a right paraduodenal hernia (Waldayer's hernia) [ 2 , 5 , 7 ]. LPDH occurs when small bowel, usually jejunum, prolapses posteroinferiorly into the defect of the left paraduodenal fossa.…”

“…In congruency with presented case, median age range at diagnosis is fourth and sixth decades, and the male to female ratio is 3:1 [ 2 ]. In this review, patients typically presented with signs and symptoms compatible with bowel obstruction secondary to incarceration, strangulation or necrosis [ 5 ]. Abdominal pain and associated symptoms being generally nonspecific, with 50% recounting recurring abdominal pain and occasionally a palpable mass [ 2 , 5 ].…”

“…Symptoms associated with paraduodenal hernias are generally nonspecific; therefore, diagnosis is most commonly due to incidental findings on imaging or at laparotomy/laparoscopy [ 4 ]. Due to the fact that paraduodenal hernias can lead to bowel obstruction, ischemia and perforation with a high mortality, an elevated index of suspicion paired with diagnostic imaging/procedure is essential to making a timely and correct diagnosis [ 5 , 6 ]. In this review, we discuss the clinical presentation and management of small bowel obstruction secondary to a left paraduodenal hernia (LPDH).…”

Left Para-Duodenal Hernia; Intestinal Obstruction, a Case Report

“…More than 50% of the cases would present with recurrent pain abdomen. 8 On the other hand it can cause acute intestinal obstruction as it was in our case which may lead to strangulation and gangrene of the involved gut. To avoid these complications a high index of suspicion is required.…”

“…Treatment includes laparotomy or laparoscopic reduction of the hernial contents as well as closure of the defect primarily or with a mesh. 8 Inferior mesenteric vein can be divided if reduction is not possible. 10 The mortality associated with PDH reported in the literature is 20-50%.…”