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Tavasolizadeh M, Dalili A. An incarcerated paraduodenal hernia of a malrotated gut in a 26-year-old man. Int J Surg Case Rep 2024; 122:110055. [PMID: 39043095 PMCID: PMC11318467 DOI: 10.1016/j.ijscr.2024.110055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction and importance: Paraduodenal hernias (PDHs) are congenital internal hernias. Overall, internal hernias are between 0.2 % and 0.9 %, while 53 % of these statistics are for PDH. There are left and right types of PDHs. CASE PRESENTATION An otherwise healthy 26-year-old man was presented with a sudden-onset epigastric and right upper quadrant abdominal pain. Abdominopelvic double contrasted CT scan revealed multiple dilated proximal-mid small bowel loops in the portal venous phase consistent with small bowel obstruction, suggesting concomitant bowel malrotation with internal paraduodenal hernia. The patient with the pre-operative diagnosis of small bowel obstruction due to volvulus was scheduled for emergency surgery. He was four weeks complication-free in his regular follow-up. CLINICAL DISCUSSION In 1857, Treitz first described PDH as a phenomenon when the primitive midgut in embryonic life abnormally rotates and causes mesocolic hernia. The location of the duodenal recess is the origin point for describing the hernia; thus, the jejunum is the most common herniating viscus. However, the stomach, small intestine, and sometimes the colon usually consist of the contents of the hernia. CONCLUSION In the absence of surgical history, abdominal wall hernia, and intra-abdominal inflammatory disease, in case of repeated abdominal pain or intestinal obstruction, and if no other causes are found, the possibility of a PDH should be kept in mind.
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Affiliation(s)
- Morteza Tavasolizadeh
- Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of General Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amin Dalili
- Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of General Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
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Cestaro G, DE Monti M, Gentile M. Paraduodenal hernia: a rare cause of bowel obstruction. Panminerva Med 2021; 63:549-551. [PMID: 34915693 DOI: 10.23736/s0031-0808.19.03827-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giovanni Cestaro
- Unit of General Surgery, Moscati Hospital, ASL Caserta, Aversa, Caserta, Italy -
| | - Marco DE Monti
- Unit of Surgery, Beata Vergine Hospital, Mendrisio, Switzerland.,Ente Ospedaliero Cantonale - EOC, Mendrisio, Switzerland
| | - Maurizio Gentile
- Unit of General and Specialist Surgery, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Xu H, Nie N, Kong F, Zhong B. Large left paraduodenal hernia with intestinal ischemia: a case report and literature review. J Int Med Res 2021; 48:300060520955040. [PMID: 32938278 PMCID: PMC7503021 DOI: 10.1177/0300060520955040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A left paraduodenal hernia is a rare type of internal hernia but the most common type of peritoneal recess hernia. Preoperative diagnosis of a left paraduodenal hernia is difficult because of its nonspecific clinical manifestations, and it is often confused with other causes of acute abdomen. Diagnosis is therefore often delayed, resulting in serious clinical outcomes. We herein report a case of a large paraduodenal hernia with small intestinal obstruction and ischemia without abdominal pain. The patient was successfully discharged after emergency hernia repair. This case reveals the importance of diagnosing a left paraduodenal hernia with or without abdominal pain, especially in patients with no history of abdominal surgery.
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Affiliation(s)
- Hao Xu
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Ning Nie
- Comprehensive Geriatric First Ward, Jinqiu Hospital in Liaoning Province, Shenyang, China
| | - Fanmin Kong
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Banghua Zhong
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, China
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Treitz Hernia: Report of a Case and Review of the Literature. Surg Laparosc Endosc Percutan Tech 2019; 29:e102-e107. [PMID: 31385923 DOI: 10.1097/sle.0000000000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Congenital hernias are rare findings, and their diagnosis is often delayed due to an incorrect interpretation of the clinical symptoms and/or images. We present a rare case of left-sided paraduodenal hernia at the ligament of Treitz, followed by a review of the literature. CASE PRESENTATION We report the case of a 20-year-old patient with unusual, recurring abdominal pain in the past 3 months. There were no previous operations or past illnesses in the patient's history. The computed tomographic scan showed a misplacement of small bowel into the lesser sack. With high suspicion of an internal hernia, we performed a diagnostic laparoscopy, which revealed a Treitz hernia. The reduction and fixation could be carried out fully with minimally invasive surgery with an uneventful postoperative course and complete recovery. CONCLUSION A Treitz hernia is a rare cause of unspecific abdominal pain and the clinical signs are difficult to interpret. However, its knowledge may help to avoid emergency procedures and provide quick recovery of the patients. We recommend the laparoscopic approach as the first choice of treatment in all cases of internal hernia in the absence of peritoneal irritation or severe bowel obstruction.
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Vu AN, Bui HT. Remember the internal hernia: laparoscopic repair of left-sided paraduodenal hernia causing acute small bowel obstruction. ANZ J Surg 2019; 90:901-902. [PMID: 31364264 DOI: 10.1111/ans.15360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Anh N Vu
- Department of General Surgery, Western Health, Melbourne, Victoria, Australia
| | - Hai T Bui
- Department of General Surgery, Western Health, Melbourne, Victoria, Australia
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Schizas D, Apostolou K, Krivan S, Kanavidis P, Katsaros I, Vailas M, Koutelidakis I, Chatzimavroudis G, Pikoulis E. Paraduodenal hernias: a systematic review of the literature. Hernia 2019; 23:1187-1197. [PMID: 31006063 DOI: 10.1007/s10029-019-01947-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Paraduodenal hernias (PDH), also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0.2-0.9% of all cases of intestinal obstruction. This is the first systematic review of all reported cases so far, investigating their clinical presentation, radiological imaging, and treatment outcomes. METHODS After a detailed search in PubMed and Medline, using the keywords "paraduodenal hernia", 115 studies matched our criteria. A review of these reports was conducted and the full texts were examined. RESULTS A total of 159 patients were included in our analysis, with 69.8% and 30.2% of them suffering from either a left or a right PDH, respectively. Mean age at diagnosis was 44.1 years, with a 2/1 male/female ratio. PDH were associated with non-specific symptoms and signs; abdominal pain being the most common. Computed tomography (CT) scan of the abdomen was the most frequently used diagnostic modality. Regardless of PDH localization, all patients were operated on, with approximately one-third of them undergoing a laparoscopic operation, which was associated with a significantly decreased morbidity rate as well as length of hospital stay, compared with the open repair. CONCLUSIONS PDH are not usually associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of knowledge and clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair, seeming to be the optimum treatment strategy.
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Affiliation(s)
- D Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - K Apostolou
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece.
| | - S Krivan
- Department of Upper Gastrointestinal and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, UK
| | - P Kanavidis
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - I Katsaros
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - M Vailas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - I Koutelidakis
- Second Department of Surgery, G.Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - G Chatzimavroudis
- Second Department of Surgery, G.Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - E Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Ma Y, Ackermann T, Mathew MK, Naqash N. Incarcerated left paraduodenal hernia causing small and large bowel obstruction. ANZ J Surg 2019; 90:E9-E10. [PMID: 30845362 DOI: 10.1111/ans.15056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/13/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Yi Ma
- Department of Upper GI and Hepatobiliary Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Travis Ackermann
- Department of Upper GI and Hepatobiliary Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Mathen K Mathew
- Department of Upper GI and Hepatobiliary Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Niyaz Naqash
- Department of Upper GI and Hepatobiliary Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
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