Small bowel obstruction secondary to left paraduodenal hernia: A case report and literature review

Abstract

HighlightsCongenital internal hernias are an infrequent condition resulting from the protrusion of abdominal organ through an intra-peritoneal defect.Left paraduodenal hernia is the most common types of congenital internal hernias.Landzert fossa is bounded by the fourth part of the duodenum from the right, the posterior peritoneum posteriorly, the inferior mesenteric vein, and left branches of the middle colic artery anteriorly.Laparotomy is mandated in cases of intestinal perforations, necrosis and hemodynamic instability.

Identification and Repair of Left-Sided Paraduodenal Hernia Using Both Laparoscopic and Robotic Techniques

“…Although rare, the adverse outcome of an unsuspected or unidentified paraduodenal hernia can result in ischemia, strangulation, and obstruction, with mortality between 20 and 50% due to delayed management [2]. CT scan with IV and by mouth contrast of the abdomen and pelvis is the recommended modality for identification of paired duodenal hernias; however, only 43% of cases are correctly identified on radiologist interpretation [13]. Patients with relapsing and remitting abdominal discomfort, postprandial pain, and history suggestive of obstructive-type pathology are the identifying factors in our case series.…”

“…Typically, patients present with recurrent undiagnosed abdominal pain, postprandial pain, and symptomatology to suggest bowel obstruction or CT evidence of bowel obstruction without prior evidence of surgical intervention. CT imaging of the abdomen and pelvis with IV and by mouth contrast is the preferred modality; however, it only has a 43% [13] predicted value of identifying a paraduodenal hernia. In our small case series, successful identification of PDH by radiologist interpretation occurred in one of the three patients.…”

“…Computed tomography (CT) is the gold standard for diagnosis for PDH [12] but only correctly identifies pathology in 43% of cases [13]. PDH will appear on CT as a cluster of dilated bowel segments, variably with an intestinal closed loop and associated engorged and displaced mesenteric vessels around the hernia orifice and sac [14].…”

Paraduodenal Hernia- An Obscure and Perilous Cause of Intestinal Obstruction.

“…In modern era, minimally invasive laparoscopic surgery is recommended in uncomplicated cases when there is no evidence of bowel ischemia or perforation in pre-operative CT scan. Laparoscopic repair is not advisable in complicated cases like gangrene or perforation of bowel, haemodynamic instability or significant adhesions [9,10].…”

Closed loop small bowel obstruction due to paracaecal internal herniation: a lesson in rarity

“…Spontaneous internal hernias are rare, the most common being of the paraduodenal type and the second most common is the paracaecal type 2 3. They can also occur through the foramen of Winslow, be transmesenteric, retroanastomotic and of the intersigmoid type 4…”