His haematological and biochemical parameters were within normal limits. The patient underwent surgery and was diagnosed having right paraduodenal hernia rph and midgut malrotation. Six types of intraabdominal herniations are generally recognized. Internal hernia is a rare and potentially lifethreatening condition that can cause intestinal obstruction, with an incidence of 0. Internal hernias arise due to abnormal protrusion of viscera through an abnormal opening in the mesentery or peritoneum within the boundaries of abdominal cavity 4. Although rph is relatively rare compared with left paraduodenal hernia, it causes high mortality as high as 50%. The authors in this case report have highlighted a unique presentation of a left paraduodenal hernia leading to.
A case of sliding right paraduodenal hernia in a 52 years old woman with chronic postprandial pain. We report a case of a left paraduodenal hernia lpdh combined with partial small bowel obstruction in a 69yearold male with. Pdf strangulated left paraduodenal hernia in an infant. The left paraduodenal hernia is three times more frequent than the right paraduodenal hernia 6. The video will further discuss the relevant anatomic boundaries of this kind of hernia, as well as the etiology and clinical presentation. Paraduodenal hernia in a 33yearold male with abdominal pain. The present report shows the case of this condition in a 65yearold male presenting with. An enhanced multidetectorrow computed tomography scan of our patient showed a. Paraduodenal hernia, also referred to as internal, congenital, retroperitoneal, or mesocolonic hernia, is a herniation resulting from anomalies of rotation and reduction of the midgut loop in the embryo. Angiography may show altered configuration of the jejunal arteries. I have a case of a laparoscopic repair of an internal hernia. May 30, 2018 background paraduodenal hernia pdh represents rare clinical entities based on few literatures.
Laparoscopic management of right paraduodenal hernia along with. The mesentery and vessels, as well as the bowel loops, are incorporated into the hernial sac. It represents alone 53% of internal hernias and 75% of paraduodenal hernias 5. There are only five prior published reports describing laparoscopic repair of a right pdh 15. Paraduodenal hernia, intestinal obstruction, internal abdominal hernia. Laparoscopic hernia repair and its validation by secondlook. It usually courses with nonspecific symptoms and a widely variable clinical presentation which makes preoperative diagnosis very difficult. However, ct evaluation of any type of internal hernia is rare in the radiology literature, except for a few reports on paraduodenal and transmesenteric hernias. Paraduodenal hernias are thought to be a congenital defect of rotation and improper fusion of the mesenteric leaflets during fetal life that creates small defects through which the bowel herniates 5 and can be. A 5yearold boy was admitted for abdominal pain with episodes of vomiting and cessation of matters and gases. She was diagnosed with a strangulated intestinal obstruction caused by right paraduodenal hernia pdh and underwent an emergency laparoscopic repair.
A 12yearold boy with a paraduodenal hernia is mentioned in a recent survey of 14 patients. Intestinal obstruction secondary to left paraduodenal hernia. Hansmann and morton reported 467 cases, though no information is available about the age of these patients. Although they are considered as a rare cause of intestinal obstruction, paraduodenal hernias are the most common type of congenital hernias.
Intraabdominal hernias are a rare cause of chronic or acute abdominal pain in childhood. The left mesentericoparietal or paraduodenal hernia is the protrusion of the intraabdominal viscera through the landzert paraduodenal fossa 6. Laparoscopic repair internal hernia medical billing and coding. Paraduodenal hernias are the most common type of internal hernias 53%1. Friday exhibit hall video presentations session 1 held during the 2017 sages annual meeting in houston, tx on fr. Paraduodenal hernia rt here the ant part of hernia is sup mesentric artery 7. Anatomically, six different types of intraabdominal. Laparoscopic hernia repair and its validation by secondlook inspection to internal. In disc extrusion, the af is damaged, allowing the np to herniate beyond the normal bounds of the disc. However it happens to be one of the common forms of internal herniation. Oct 17, 2014 left paraduodenal hernia left paraduodenal hernias have an overall incidence of approximately 40% of internal hernias. Paraduodenal hernias frequently present subtle findings on barium contrast studies. Case presentation we report five cases of paraduodenal hernia, all occurring in male patients ranging from 34 to 75 years of age.
They result from the dorsal malrotation of the midgut, an. They occur when bowel prolapses through landzerts fossa, an aperture present in approximately 2% of the population these hernias therefore can be classified as a congenital type, normal aperture subtype. The left paraduodenal fossa results from failure of mesenteric fusion with the parietal peritoneum and malrotation of the midgut resulting in development of a potential space 3. After clinical and paraclinical investigations, the diagnosis of occlusion was accepted and. It is due to the prolapse of bowel through fossa of landzert. Paraduodenal hernia pdh, though uncommon, is a surgical emergency associated with high risk of strangulation and incarceration. Laparoscopic treatment of left paraduodenal hernia in two cases of. Paraduodenal hernias are the most common form of congenital internal hernias, accounting to approximately 4050% of the total 24. This video will discuss an interesting case of a 43 year old female with intermittent crampy abdominal pain. The mortality of obstructed internal hernia exceeds 50%,6, 8 reflecting the large proportion of patients who present with intestinal obstruction and ischaemia requiring emergency surgery. The paraduodenal hernia is the most frequent of internal hernias. A left paraduodenal hernia causing recurrent small bowel. Right small bowel followthrough demonstrates an ovoid cluster of mildly dilated jejunal segments in the left upper quadrant.
Sep 01, 2011 internal hernia is a rare and potentially lifethreatening condition that can cause intestinal obstruction, with an incidence of 0. She underwent diagnostic laparoscopy which revealed a somewhat unexpected finding of a right paraduodenal hernia. Paraduodenal hernia pdh, a rare congenital anomaly, is a type of. A 56yearold japanese female presented with vomiting, nausea, and abdominal pain after excessive drinking and eating. It is seldom diagnosed preoperatively and a small bowel followthrough series is the best. An internal hernia is classically defined as herniation of a viscus through a normal or abnormal aperture within the boundaries of the peritoneal cavity. Approximately 53% of reported cases of internal hernia are paraduodenal, comprising left 40% and right % paraduodenal hernias 2.
Apr 20, 2019 paraduodenal hernias pdh, also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0. He examined four patients with paraduodenal hernias causing intestinal obstruction. Acute intestinal obstruction secondary to left paraduodenal. Rph is a type of internal hernia and is frequently associated with intestinal malrotation. Paraduodenal hernia, also called mesocolic hernia, is a type of internal hernia that is thought to be caused by a congenital defect involving abnormal retroperi. Paraduodenal hernias result from a congenital deficiency in mesenteric peritoneal fixation. The most common internal hernia is strangulating sbo, which occurs after a closedloop obstruction. Laparoscopyassisted repair for intersigmoid hernia abstract. Background left paraduodenal hernia pdh makes for around 40% of all internal hernias. Identification and repair of leftsided paraduodenal hernia using.
A 30yearold man was admitted with a oneyear history of intermittent abdominal pain and a more recent fourmonth history of projectile vomiting. Paraduodenal hernias result from abnormal rotation of the midgut during embryonic. Left sided paraduodenal hernia is more common in which small bowel herniates through the fossa of landzert, a congenital failure of fusion of the descending colon mesentery to the peritoneum in the left upper quadrant. Oct 17, 2019 overall incidence of internal hernias is 0. Abdominal computed tomography showed an encapsulated circumscribed cluster of jejunal loops in the right upper quadrant. Paraduodenal hernias pdh, also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0.
A causal relationship between right paraduodenal hernia. Paraduodenal hernias comprise 50% of all congenital internal hernias. Right paraduodenal hernia federal practitioner mdedge. The omentum, mesentery, and peritoneal cavity diagnostic. Paraduodenal hernias are the commonest type of internal hernia.
The laparoscopic repair of paraduodenal hernia is sporadically. However, unlike malrotation, the duodenum crosses the midline and the cecum is located in the right lower quadrant. It is named after jacques benigne winslow 16691760, a danishborn french anatomist. Paraduodenal hernia presenting as unexplained recurrent abdominal pain. 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. The association between paraduodenal hernias and small bowel obstruction is well known. Paraduodenal hernias comprise the most common form of congenital internal hernia however, due to the rarity of this condition, there is no. Laparoscopic paraduodenal hernia repair with bioabsorbable mesh. An internal hernia is the protrusion of a viscus through a normal or abnormal opening within the confines of the abdominal cavity. Lumbar disc herniation ldh is a common low back disorder. Identification and repair of leftsided paraduodenal. Paraduodenal hernias, are the most common type of internal hernia.
Right and left paraduodenal hernias are distinct and separate. Laparoscopic repair of a right paraduodenal hernia sages. This hernia is presumed to be spontaneously reducible in many patients with recurrent symptoms. They result from incomplete rotation of the midgut, with part of the small intestine trapped posterior to the mesocolon. The patients had varied manifestations presenting with abdominal pain with or without vomiting and nausea and with or without signs of intestinal obstruction. Understanding the anatomical features of the paraduodenal region in such patients is. After a detailed search in pubmed and medline, using the. The symptoms include chronic abdominal pain and acute intestinal. Identification and repair of leftsided paraduodenal hernia. It has been associated with a high rate of complications, including bowel.
In the right paraduodenal hernia the major findings consist of encapsulation of small bowel loops in the right midabdomen with looping of arterial and venous jejunal branches behind the. Paraduodenal hernia is a rare cause of intestinal obstruction. Congenital left mesentericparietal hernia associated to a. Laparoscopic repair of right paraduodenal hernia in adult.
Mozaffar m, hasani m, fallah m, sobhiyeh mr, adhami f. Internal hernias are the etiology of paraduodenal hernias being the most common type of congenital internal hernia. A causal relationship between right paraduodenal hernia and. Apr 01, 1970 paraduodenal hernias frequently present subtle findings on barium contrast studies. Laparoscopic paraduodenal hernia repair sages abstract.
The number of these cases reported in literature is sparse making it a rare form of hernia necessitating detailed study. The herniated bowel exerts mass effect on the greater curvature of the stomach, characteristic of a left paraduodenal hernia. Among the congenital internal hernias, paraduodenal hernias are the most common and account for 25%53% of all cases 1. Left paraduodenal hernia why herniate outside when you. With a diagnosis of an incarcerated internal hernia, the patient underwent emergency laparoscopyassisted surgery. Paraduodenal hernias, being the most common type of congenital internal hernias, are responsible for. Suture repair of paraduodenal hernia can be reinforced using bioabsorbable mesh. Case report laparoscopic repair of paraduodenal hernia. Paraduodenal hernia is an uncommon cause of intestinal obstruction. The left mesentericoparietal hernia or left paraduodenal hernia is an anomaly of intestinal rotation which may be responsible for intestinal obstruction. We report the presentation and management of pdh in our hospital. All pdhs diagnosed from 2003 to 2014 were identified from a hospital database. Although uncommon, paraduodenal hernias carry a mortality rate between 20% and 50% as a result of delayed diagnosis and associated volvulus, ischemia, strangulation, and obstruction. This hernia occurs when the small intestine becomes trapped beneath the colon because of anomalous rotation of the mesentery of the.
Left abdominal radiograph shows an unusual cluster of dilated jejunal small bowel loops in the left upper quadrant. An internal hernia congenital or acquiredis a protrusion of bowel through an opening in the peritoneum or mesentery. Left paraduodenal hernia pdh makes for around 40% of all internal hernias. Paraduodenal hernias are the most common type in adults. A left paraduodenal hernia causing bowel obstruction. Jan 16, 20 introduction an internal hernia is a protrusion of bowel through a normal or abnormal orifice in the peritoneum or mesentery. May 27, 2010 introduction cases of right paraduodenal hernia and superior mesenteric artery syndrome have been reported separately, but their occurrence in combination has not been reported. Introduction 1paraduodenal hernias, also called congenital. Laparoscopic paraduodenal hernia repair sages abstract archives. Abstract paraduodenal hernia is an uncommon cause of intestinal obstruction. Case presentation a 46yearold japanese man who had never undergone laparotomy was admitted to our hospital due to an acute abdomen. In the right paraduodenal hernia the major findings consist of encapsulation of small bowel loops in the right midabdomen with looping of arterial and venous jejunal branches behind the superior mesenteric artery. They are either left 75% or right sided 25%, and distinct in their pathogenesis3, 19, 29, 30, 31, 32.
Laparoscopic repair of a right paraduodenal hernia ncbi nih. Paraduodenal hernias, although uncommon, have classically been the most common type of internal hernia. Atif iqbal, department of surgery, university of florida gainesville, florida, p. Its rarity is due to an under estimation because it is usually asymptomatic and discovered in intraoperative and during postmortems 3, 4. Left paraduodenal hernia successfully treated with. Right paraduodenal hernia is an unusual congenital malformation that causes intestinal obstruction. Iqbal a, 1 cuenca a 2 and jameel r 3 1 department of surgery, university of florida, usa 2 department of pediatric surgery, boston childrens hospital, usa 3 department of medicine, ksa corresponding author. Left paraduodenal hernia is a rarely found condition in which the small bowel herniates through a congenital peritoneal defect located behind the 4th portion of duodenum. Diagnosis of pdh remains challenging due to its nonspecific presentation. He was brought to the or for a diagnostic laparoscopy converted to an open left paraduodenal hernia repair. Paraduodenal hernias represent a subset of internal hernias and are found on autopsy in 0. It is due to the prolapse of bowel through fossa of landzert, an anatomic variant that is found in around 2% of the population. The computed tomographic ct findings of a right and left paraduodenal hernia are described.
Paraduodenal hernias are relatively rare congenital malformations and account for 30 to 53 per cent of all internal hernias. Jan 01, 2017 paraduodenal hernias into the left paraduodenal fossa of landzert are three times more common than those into the right paraduodenal fossa of waldayer 2. Paraduodenal hernia represent 53% of internal hernias 1, 5. Kummers description was illustrated in a precise, text book manner in the. The paraduodenal hernia is an internal hernia that might cause a small bowel obstruction.
Methods a literature search using pubmed was performed to identify all published cases of left paraduodenal hernia lpdh. A left paraduodenal hernia causing recurrent small bowel obstruction. Left paraduodenal hernia why herniate outside when you can. The rarity of internal hernias can be explained from the fact that they are usually asymptomatic and then their symptomatology is. Paraduodenal hernias are the commonest type of internal hernia, affecting 23% of the population. Paraduodenal hernias pdh, also called congenital mesocolic hernias. The only thing i can find is the unlisted code 49659unlisted laparoscopy procedure. A case report of left paraduodenal hernia with a spontaneous. Paraduodenal hernias arise from a deficiency in midgut rotation.
Laparoscopic repair of a left paraduodenal hernia presenting with acute bowel obstruction. Internal hernias are an uncommon cause of small bowel obstruction and present a challenging clinical diagnostic scenario. It occurs typically in adults, but can also present in children. Treitz retroperitoneal hernia, hernia of the fossa of landzert, mesentericoparietal hernia of logace and hernia into the descending mesocolon of callader 6. They were all successfully managed by a laparoscopic repair. Case presentation the present report shows the case of this condition in a 65year.
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