Left paraduodenal hernia: Embryological and radiological findings

Abstract

Left paraduodenal hernia (PDH), may present as a surgical emergency with an increased risk of strangulation and incarceration. The diagnosis is challenging because of the non-specific presentation. In the absence of common epigastric or upper abdominal pathology and non-resolving symptoms, a high index of suspicion is required to diagnose left PDH. This report describes a case of radiologically diagnosed left paraduodenal hernia and subsequent successful surgery. It also includes a review of midgut embryology, and the anatomy and radiology of left PDH.

A late presentation of a left paraduodenal hernia in an elderly patient admitted in emergency: A case report

“…It also extends behind the descending mesocolon [ 2 , 11 , 16 – 19 ]. This anatomical region is the crossroad between the descending mesocolon, transverse mesocolon, and small bowel mesentery [ 11 , 17 , 18 ]. The IMV and the ascending LCA are the most important vascular landmarks.…”

“…PDHs are usually congenital and caused by a malrotation of the mid-gut and they lead to an incomplete fusion of the retroperitoneum [ 17 , 18 ]. The LPHs are usually caused by the unsuccessful fusion of part of the descending mesocolon to the posterior peritoneum [ 11 , 17 , 18 ].…”

Large left paraduodenal hernia identified and repaired by laparoscopy: A case report

“… 4 , 7 Left PDHs usually present in the 4th to 6th decades of life, with a mean age of presentation at 38.5 years. 1 Since these hernias are rarely seen in practice, it is important for clinicians and radiologists to familiarise themselves with the condition because an unidentified PDH can result in ischaemia, strangulation, intestinal obstruction and fatality. 1 , 5 …”

“…4,7 Left PDHs usually present in the 4th to 6th decades of life, with a mean age of presentation at 38.5 years. 1 Since these hernias are rarely seen in practice, it is important for clinicians and radiologists to familiarise themselves with the condition because an unidentified PDH can result in ischaemia, strangulation, intestinal obstruction and fatality. 1,5 This case report illustrates the importance of taking a detailed medical history because, similar to our patient, approximately 50% of patients recall previous nonspecific, recurrent, abdominal pain, 8 which typically worsens after meals and improves with body position.…”

“…Paraduodenal hernia (PDH) is a rare congenital condition caused by abnormal rotation and fixation of the midgut during embryonic development. 1 The hernia can be broadly separated into left and right and PDHs account for up to 53% of all internal hernias and 0.2–0.9% of small intestinal obstructions. 2 A PDH poses a significant diagnostic and therapeutic challenge for clinicians because of its rarity and the fact that it can present with non-specific symptoms ranging from digestive disorders and chronic abdominal pain to symptoms of intestinal obstruction.…”