Laparoscopic Repair of Right Paraduodenal Hernia in Adult Patients: Case Report and Literature Review

Abstract

A 56-year-old Japanese female presented with vomiting, nausea, and abdominal pain after excessive drinking and eating. Abdominal computed tomography showed an encapsulated circumscribed cluster of jejunal loops in the right upper quadrant. She was diagnosed with a strangulated intestinal obstruction caused by right paraduodenal hernia (PDH) and underwent an emergency laparoscopic repair. A view through the endoscope showed the right PDH, which was encapsulated under the mesocolon. Most of the small bowel was entrapped and adhered inside the sac, requiring careful adhesiolysis. The hernia orifice was expanded to a sufficient degree, and the strangulation was relieved, avoiding the need of resecting the small intestine. Recovery was uneventful, and the patient remains free of symptoms 3 years after surgery. Findings in a total of 29 patients (including this report) who underwent laparoscopic repair of right or left PDHs in Japan are discussed.

Laparoscopic repair of a right-sided paraduodenal hernia

“…Therefore, opening the hernial sac in such cases is usually sufficient [10]. In accordance with other reports in the literature, the laparoscopic method is recommended as it yields the best postoperative outcome [8].…”

“…The second option is to dissect and remove Ladd’s bands which extend from the large intestine to the duodenum and result from embryonic maldevelopment. The cecum is then mobilized, and the pre- and postarterial segments of the intestine are returned to their anatomical positions [8, 10].…”

Minimally invasive management of a paraduodenal hernia with intestinal malrotation

“…A left PDH involves the paraduodenal fossa of Landzert, which is located lateral to the fourth segment of the duodenum and posterior to the inferior mesenteric vein and left colic artery [ 5 ]. The small bowel herniates into the left mesocolon and is entrapped between the mesocolon and the posterior abdominal wall [ 6 ]. In the right PDH, the small bowel becomes trapped behind the right mesocolon and mesentery of the cecum.…”

Identification and Repair of Left-Sided Paraduodenal Hernia Using Both Laparoscopic and Robotic Techniques

“…Internal hernias are a rare cause of small bowel obstruction that result from the abnormal protrusion of an abdominal organ through a peritoneal defect. Paraduodenal hernias (PDH) arise as a result of the failure of fixation of either the left or transverse mesocolon to the posterior abdominal wall and account for 53% of all internal hernias [1]. Although uncommon, paraduodenal hernias carry a mortality rate between 20% and 50% [2] as a result of delayed diagnosis and associated volvulus, ischemia, strangulation, and obstruction [3].…”

“…Time from onset of initial symptoms to diagnosis does not differ significantly between right-and left-sided PDH [1]. Definitive treatment involves laparoscopy or exploratory laparotomy for direct visualization, reduction, possible lysis of adhesions to release of bowel from the hernia sac, reorientation of small bowel segments to their normal anatomical positions, repair of the hernia defect with suture or widening to avoid future obstruction, and, rarely, application of mesh [18].…”