Left paraduodenal hernia: a rare cause of acute abdomen

Abstract

Paraduodenal hernia is a rare congenital anomaly that arises from an error of rotation of the midgut. The duodenum and the small intestine become trapped in a sac which is lined by the peritoneum, behind the mesentery of the colon, either to the right or left of the midline. It is therfore a rare and potentially life-threatening condition that can cause intestinal obstruction progressing to strangulation and perforation. We report a case of a 55-year-old patient presenting a left paraduodenal hernia diagnosed intraoperatively after being operated on in the emergency setting for acute abdomen. The small bowel was twisted upon its mesentery and was entrapped in a large left paraduodenal space. Fortunately, once the bowel was reduced from the paraduodenal space, the blood flow was reestablished and the small bowel resumed a proper functioning. The mouth of the sac was obliterated by suture opposition to the posterior wall. The patient's subsequent hospital course was uneventful, and he was discharged in satisfactory condition 4 days postoperatively.

Laparoscopic treatment of acute small bowel obstruction due to left paraduodenal hernia: A case report and literature review

“…Usually, males are more affected than females (3:1) and the fourth-sixth decade of life turns out to be the most involved [2] , [4] . There are many theories about the origin of paraduodenal hernias, but the most widely accepted one is that they are the result of an embryological error that occurs during the process of rotation and bowel fixation leading to entrapment of the small bowel between the mesocolon and the posterior abdominal wall [1] , [2] , [4] , [25] . Right and left paraduodenal hernias are separate entities, which differ in anatomical location and embryological origin.…”

“…Left paraduodenal hernias are congenital anomalies that arise during the rotation of the digestive tract, when the small bowel invaginates in an avascular segment of transverse-descending mesocolon, localizing into a fossa (Landzert’s fossa) to the left of the fourth part of the duodenum, posterior to the inferior mesenteric vein and to left branches of the middle colic artery ( Fig. 5 ) [1] , [2] , [4] , [12] , [25] . At autopsy, the Landzert’s fossa was found in about 2% of the population [10] , [12] , [25] .…”

“…5 ) [1] , [2] , [4] , [12] , [25] . At autopsy, the Landzert’s fossa was found in about 2% of the population [10] , [12] , [25] . A left paraduodenal hernia usually contains the majority of the small bowel, from the fourth part of the duodenum to the terminal ileum, while the colon usually lies in its anatomically correct position.…”

“…A left paraduodenal hernia usually contains the majority of the small bowel, from the fourth part of the duodenum to the terminal ileum, while the colon usually lies in its anatomically correct position. Only infrequently can the descending colon be found to the right of the hernia [25] . In the right paraduodenal hernia the small bowel herniates through a defect in the first part of the jejunal mesentery in the so called Waldeyer’s fossa [2] , [25] .…”

“…Only infrequently can the descending colon be found to the right of the hernia [25] . In the right paraduodenal hernia the small bowel herniates through a defect in the first part of the jejunal mesentery in the so called Waldeyer’s fossa [2] , [25] . At autopsy, the Waldeyer’s fossa was found in about 1% of the population [12] , [25] .…”