Left paraduodenal hernia presenting as recurrent small bowel obstruction

Abstract

Internal herniation of the small bowel is a relatively rare cause of intestinal obstruction. Left paraduodenal hernia resulting from abnormal rotation of the midgut during embryonic development is the most common form of congenital internal hernia. We report our experience in the diagnosis and management of a young male with left paraduodenal hernia presenting as recurrent intestinal obstruction. Correct preoperative diagnosis of left paraduodenal hernia had been difficult due to non-specific clinical presentations, but the advent of modern imaging technology makes early and correct diagnosis possible. Due to the risk of obstruction and strangulation, surgical treatment is indicated; however, timely intervention increases the likelihood of a favorable outcome.

A rare case that caused high-level intestinal obstruction: left paraduodenal hernia

“…They may sometimes be asymptomatic and can be incidentally identified by imaging studies performed for other reasons, during laparotomy or autopsy series (2,6,9,10). Clinical symptoms are in the form of recurrent cramp-like abdominal pain, intestinal obstruction due to torsion, nausea, vomiting and abdominal distention (3,5). Tong et al (9) evaluated 32 cases, and they reported that chronic symptoms are seen in 69% of patients and that 66% of patients present with acute obstruction or strangulation.…”

“…Paraduodenal hernia is observed 3 times more in the left than in the right (3, 5-7, 9, 10). It is most commonly seen in the 4th and 6th decades (3,5). Its occurrence in men is three times more common than in women (3,5,6,9).…”

“…It is most commonly seen in the 4th and 6th decades (3,5). Its occurrence in men is three times more common than in women (3,5,6,9). During a lifetime, half of the cases carry a risk of intestinal obstruction or strangulation, whereas the other half can remain silent (5).…”

“…Internal hernia is a rare cause of acute abdomen, and can lead to intestinal obstruction and ischemia if not diagnosed and treated in time (2,3). Internal herniation constitutes 0.6 to 5.8% of patients with intestinal obstruction (4)(5)(6).…”

“…Internal herniation constitutes 0.6 to 5.8% of patients with intestinal obstruction (4)(5)(6). Paraduonenal hernia is the cause of approximately 50% of internal hernias and is responsible for approximately 1% of all small bowel obstructions (2,3,(5)(6)(7)(8)(9). Transmesenteric hernia, foramen of Winslow hernia, paracecal hernia and transomental hernia are other types of congenital internal hernias (6).…”