Right paraduodenal hernia: report of two cases and review of literature

Abstract

Paraduodenal hernia (PDH), a rare congenital anomaly, is a type of internal hernia which occurs due to a defect in the reduction and rotation of the midgut. On anatomical and embryological basis, PDH can be broadly divided into right- and Left PDH. Right PDH is rarer than its counterpart. We present two cases of Right PDH. The patientsy presented with a history of recurrent intestinal obstruction since childhood, which was managed conservatively, without a definitive diagnosis. Once they presented to us, a detailed clinical history and a barium meal follow- through clinched the diagnosis of PDH. Intra-operative findings correlated well with the clinical diagnosis. The jejunal loops had herniated through the fossa of Waldeyer. Reduction of hernia contents and excision of the hernia sac was carried out. Post-operatively, the patients are healthy and symptom-free at 4 and 3 years follow-up, respectively. The rarity of this condition and the need for early diagnosis, to prevent the high risk of bowel obstruction and strangulation, makes PDH one of the difficult challenges for the clinicians.

Intestinal obstruction due to the fossa of Waldeyer hernia

“…The classic finding of a paraduodenal hernia on a contrast study was an empty pelvis devoid of small bowel in the upright position with small bowel loops trapped in a smooth mass. The mass will be predominantly right or left-sided depending on the laterally of the paraduodenal hernia (4).…”

“…The first method involves the opening of the sac laterally and reducing the trapped small bowel followed by excision of the sac. The second method involves the right medial visceral rotation to deliver the herniated small bowel (4). We utilized the first method in our patient.…”

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

“…PDH accounts for 53% of internal hernias, but only 0.2% to 5.8% of intestinal obstructions, and occurs in both adults and children [ 3 ]. Patients with PDH present with various symptoms, including those of acute or chronic obstruction and intermittent abdominal pain associated with nausea and vomiting [ 1 ], and some patients may present with a history of recurrent intestinal obstruction since childhood [ 4 ]. Two variants of PDH are known, right-sided and left-sided, with the latter being more common.…”

Wilhelm von Waldeyer-Hartz—A Great Forefather: His Contributions to Anatomy with Particular Attention to “His” Fascia

“…He coined the phrases “chromosome” and “neuron” with their anatomical–morphological concepts. Numerous terms which are less common today are associated with his name: he systemized the labels of the appendix testes [Paradidymis/Giraldé’s Organ, Appendix testis and epididymidis, among others ( 6 )], the “Waldeyer White Line” refers to the line connecting the ovary with the peritoneum, the “Waldeyer-Tract” refers to the “dorsolateral fasciculus” on the spinal cord (also known as: Lissauer bundle), “Waldeyer’s fossa” describes a recess which is occasionally found behind the superior mesenteric artery in the region of the mesenteric root ( 2 , 7 , 8 ), the “Waldeyer sheath” which is the tubular space between the bladder wall and the intra-mural part of the ureter. His memoirs appeared in 1920 [Figures 2 and 3 ; ( 3 )].…”