Left Paraduodenal Hernia Successfully Treated with Laparoscopic Surgery: A Case Report

Abstract

A 60-year-old Japanese man was referred for examination of abdominal pain. Abdominal MRI exactly demonstrated paraduodenal hernia. Propylthiouracil was administered until the patient became euthyroid, because Graves’ disease was detected during the subsequent general examinations. Laparoscopic repair was then carried out. The sac collar, which had a diameter of about 30 mm, was located lateral to the ascending portion of the duodenum. Bowel incarcerated in the hernia sac was reduced and the hernia orifice closed. The postoperative course was good, and the patient was discharged 7 days after surgery. The diagnosis by MRI has made possible laparoscopic surgery for paraduodenal hernia.

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

“…Plain abdominal X-rays show displacement of bowel loops to an area and air -fluid levels (5-7, 9). Visualization of dilated bowel loops clustered between the stomach, pancreas and spleen is diagnostic and typically extension of the vascular structures supplying the herniated loops into the hernia sac can be monitored (2,3,5,7,9). In our case, physical examination and radiologic findings described in the literature were observed.…”

“…Defect in fusion of the mesentery and posterior parietal peritoneum creates a potential hernia orifice (2,4). In left paraduodenal hernias, the jejunal loops are herniated through this opening located to the left of the ligament of Treitz (4).…”

“…Clinically, in majority of the patients, episodes of partial or complete intestinal obstruction are observed (12,13). 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).…”

“…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).…”