1
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Lampropoulos C, Kehagias D, Bellou A, Tsochatzis S, Kehagias I. Minimally invasive surgery for paraduodenal hernias: report of a case and mini-review of operative techniques. Acta Chir Belg 2024; 124:234-242. [PMID: 37477598 DOI: 10.1080/00015458.2023.2240106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Paraduodenal hernias (PDHs) are the most common congenital internal hernias. Herein, we present a successful laparoscopic repair of a left PDH and we review the minimally invasive techniques that have been used to treat PDHs. MATERIALS AND METHODS An 18-year-old female patient with multiple visits to the emergency department for abdominal pain was ultimately diagnosed with a left PDH. She underwent a four-port laparoscopic repair. In order to review the minimally invasive PDH repair techniques used, we searched the PubMed® database and found 53 original studies with a total of 66 minimally invasive PDH repairs (51 left PDH repairs, 15 right PDH repairs) over a period of 24 years (1998-2022). RESULTS The patient's postoperative course was uneventful and she was discharged on the 7th postoperative day. The literature review showed that closure of the hernia orifice was performed in 88% of left PDH repairs, whereas wide opening of the hernia orifice with or without mobilization of the right colon was performed in 81% of right PDH repairs. Of the patients with available postoperative data, none experienced complications other than grade Ι according to the Clavien-Dindo classification in the early postoperative period, and only one patient presented symptomatic hernia recurrence at a median follow-up of 1 year. CONCLUSIONS Based on limited publications and our own experience, minimally invasive repair of PDHs has so far been shown to be feasible and safe in the great majority of cases without irreversible small intestine ischemia/peritonitis.
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Affiliation(s)
| | - Dimitrios Kehagias
- Department of General Surgery, General University Hospital of Patras, Rio, Greece
| | - Aggeliki Bellou
- Intensive Care Unit, Department of Anesthesiology and Intensive Care Medicine, General University Hospital of Patras, Rio, Greece
| | | | - Ioannis Kehagias
- Department of General Surgery, General University Hospital of Patras, Rio, Greece
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2
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Brogna B, Urciuoli L, Musto LA, Iovine L. A late presentation of a left paraduodenal hernia in an elderly patient admitted in emergency: A case report. Radiol Case Rep 2024; 19:1356-1360. [PMID: 38288049 PMCID: PMC10823032 DOI: 10.1016/j.radcr.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/31/2024] Open
Abstract
Small bowel internal hernias (IHs), a rare cause of small bowel occlusion (SBO) and small bowel strangulation, while more commonly seen in young adults, can also affect elderly patients and pose a significant diagnostic challenge due to their nonspecific symptoms. In most cases, laparotomy was used to diagnose IHs. However, multidetector computed tomography (MDCT) is usually the best imaging tool to use in the emergency setting for the diagnosis of IHs. An 83-year-old man was admitted to emergency with acute abdominal pain and a coffee-ground vomitus. The abdominal MDCT showed a clustered-like appearance of proximal jejunal loops at the level of the Treitz ligament with the absence of transit of the medium water-soluble iodine oral contrast agent (Gastrografin). Mesenteric edema was also present with initial suffering of the intestinal wall. A left paraduodenal hernia (LPDH) with strangulation was suspected following the radiological report. The emergency laparotomy revealed about 20 cm of proximal jejunal loops herniated through a 3 cm wide hernia orifice (HO) along the Treitz ligament, at the level of Landzert fossa, located in the confluence of the descending mesocolon, posterior to the inferior mesenteric vein (IMV) and confirming the LPDH. The patient was discharged in good condition some days later. IHs do not have sufficient coverage in literature, especially in cases regarding elderly patients, however, they can be a cause of SBO in people older than 80 years of age. Radiologists and surgeons should be aware of the anatomical aspects of the IHs.
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Affiliation(s)
- Barbara Brogna
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Luigi Urciuoli
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Lanfranco Aquilino Musto
- Department of Interventional and Emergency Radiology, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Lorenzo Iovine
- Department of Surgical Emergency, San Giuseppe Moscati Hospital, Avellino, Italy
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3
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Giri OA, Bhat SN, Kuppusamy B. Lessons learnt in the management of paraduodenal hernias: a case series. Surg Endosc 2024; 38:443-448. [PMID: 38010410 DOI: 10.1007/s00464-023-10513-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 10/08/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Paraduodenal hernias (PDH) are rare congenital internal hernias with non- specific symptoms. Left-sided paraduodenal hernia is three times more common than right-sided paraduodenal hernia with similar clinical presentation but different embryological origins. MATERIALS AND METHODS We report a series of eight cases of paraduodenal hernia who presented with varied clinical presentation ranging from vague abdominal pain to complete intestinal obstruction. Six cases had left-sided paraduodenal hernia, while two cases had right-sided paraduodenal hernia. RESULTS Seven cases based on their presentation underwent surgery either electively or on emergent basis. Three cases underwent laparoscopic repair. One case had a recurrence and was re-operated four months later. There was no mortality among any of the cases. CONCLUSION A pre-operative diagnosis of paraduodenal hernia is essential. Laparoscopic surgery is safe in select cases and is found to be beneficial.
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Affiliation(s)
- Oviya Anjali Giri
- Department of General and GI Surgery, PSG Institute of Medical Sciences and Research Centre, Coimbatore, India
| | - Sunay N Bhat
- Department of General and GI Surgery, PSG Institute of Medical Sciences and Research Centre, Coimbatore, India.
| | - Balu Kuppusamy
- Department of Surgical Gastroenterology, PSG Institute of Medical Sciences and Research Centre, Coimbatore, India
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4
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Hina A, Zahid MJ, Jan MA, Haseeb A, Hussain M. From Recurrent Pain to a Life-Threatening Condition: A Case Report of Left Paraduodenal Hernia. Cureus 2023; 15:e42596. [PMID: 37641743 PMCID: PMC10460500 DOI: 10.7759/cureus.42596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Paraduodenal hernia (PDH) is the most frequent type of congenital hernia, especially on the left side. Although acute intestinal obstruction due to internal hernias is rare, it can be life-threatening if not detected and treated promptly. Here, we present the case of a 36-year-old man who presented to the emergency department with an acute intestinal obstruction that had been developing for three days. The patient had a history of recurrent abdominal pain but had never undergone any abdominal surgery. Surgical exploration revealed a left internal PDH with a collection of incarcerated jejunal loops retrocolically encased within the hernial sac. Resection of the gangrenous jejunal loops was performed, followed by hernia reduction and neck closure. This case highlights the importance of timely and accurate diagnosis of left PDHs, particularly in patients with a history of recurrent abdominal pain and no prior abdominal surgeries. Early detection and treatment can prevent life-threatening complications such as intestinal perforation and peritonitis.
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Affiliation(s)
- Ayesha Hina
- Department of Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | | | | | - Abdul Haseeb
- Department of Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Musarrat Hussain
- Department of Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
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5
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Sghaier A, El Ghali MA, Fradi K, Chahed M, Hamila F, Youssef S. Extensive small bowel necrosis due to congenital para duodenal hernia: A diagnostic and therapeutic challenge: Case Report. Int J Surg Case Rep 2023; 108:108423. [PMID: 37348200 PMCID: PMC10382767 DOI: 10.1016/j.ijscr.2023.108423] [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: 05/11/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION A paraduodenal hernia is a rare variety of hernia, however it is the most usual type of internal hernias. Clinical presentation is nonspecific. The clinical presentation is variable: indeed, the patient can be completely asymptomatic or present with symptoms which severity is variable according to the mechanism. The most common cause is an acute intestinal occlusion that could progress even to ischemia and intestinal necrosis. Depending on the clinical presentation and the suspected diagnosis, computed tomography can be of considerable help in demonstrating a para duodenal hernia. CASE PRESENTATION We describe the case of a young man aged 18 years, who presented to the emergency unit with severe abdominal pain associated with incoercible vomiting. The surgical exploration had confirmed a para duodenal hernia responsible for an extensive necrosis of the small intestine allowing viable 90 cm only. CASE DISCUSSION Paraduodenal hernias are rare and their diagnosis is not always easy. Therefore, they should be considered especially in the case of an occlusive syndrome occurring in a young patient who has never been operated on. If no treatment is undertaken, the evolution is drastic and the mortality rate is significant. CONCLUSION Successful surgical management requires knowledge of the intra-abdominal peritoneal spaces and management of suggestive clinical situations in order to reduce postoperative morbidity and mortality resulting from delayed diagnosis and treatment.
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Affiliation(s)
- Asma Sghaier
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia.
| | - Mohamed Amine El Ghali
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia
| | - Khalil Fradi
- Hospital of Farhat Hached of Sousse, Tunisia; Department of General Surgery, Tunisia
| | | | - Fehmi Hamila
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia
| | - Sabri Youssef
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia
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6
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AlSafadi R, Smyk D. Fatal Bowel Obstruction Due to Paraduodenal Hernia: A Case Report. Pediatr Dev Pathol 2023:10935266231167000. [PMID: 37082925 DOI: 10.1177/10935266231167000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
A paraduodenal hernia is a rare type of hernia, however it is the most common type of internal hernias. It can develop after surgery, trauma, or be congenital. Paraduodenal hernias are rare in children. Clinical presentation is nonspecific. Patients range from being asymptomatic to presenting with clinical symptoms associated with small bowel obstructions. Diagnostic tools such as X-ray, plain abdominal radiography, and computed tomography may be used to diagnose paraduodenal hernias. Described is the case of a 5-year-old female who died suddenly of a bowel obstruction due to a paraduodenal hernia found at postmortem examination. In the hours prior to death, she reported stomach pain, vomiting, and later developed a fever. Postmortem CT study showed free fluid in the abdomen and bowel distention. Internal examination showed an obstructed bowel with ischemic sections extending from the distal portions of the small bowel up to the proximal portions of the transverse colon. The ischemic portions were entrapped within a clear membranous sac within the abdominal cavity. The sac was concluded to be a paraduodenal hernia. Paraduodenal hernias are rare and difficult to diagnose but they must be considered in the diagnostic process, as without surgical intervention the mortality rate can be high.
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Affiliation(s)
- Rawan AlSafadi
- Ontario Provincial Forensic Pathology Unit, Toronto, ON, Canada
| | - Daniel Smyk
- Ontario Provincial Forensic Pathology Unit, Toronto, ON, Canada
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7
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Trabelsi MM, Oueslati A, Kammoun M, Jerraya H, Bouasker I, Nouira R. Paraduodenal hernia: An exceptional cause of acute bowel obstruction. Clin Case Rep 2023; 11:e6886. [PMID: 36721681 PMCID: PMC9880382 DOI: 10.1002/ccr3.6886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/03/2022] [Accepted: 01/03/2023] [Indexed: 01/28/2023] Open
Abstract
Internal hernias represent only 0.2%-0.9% of all causes of bowel obstruction. A 59-year-old patient presented urgently with small bowel obstruction. Laparotomy revealed a left paraduodenal hernia with most of the small bowel herniating through a space between the inferior mesenteric vein and duodenojejunal junction.
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Affiliation(s)
| | | | - Mehdi Kammoun
- Department B of surgeryCharles Nicolle HospitalTunisTunisia
| | - Hichem Jerraya
- Department B of surgeryCharles Nicolle HospitalTunisTunisia
| | | | - Ramzi Nouira
- Department B of surgeryCharles Nicolle HospitalTunisTunisia
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8
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Lamprou V, Krokou D, Karlafti E, Panidis S, Kougias L, Tzikos G, Ioannidis A, Netta S, Thomaidou E, Paramythiotis D. Right Paraduodenal Hernia as a Cause of Acute Abdominal Pain in the Emergency Department: A Case Report and Review of the Literature. Diagnostics (Basel) 2022; 12:2742. [PMID: 36359585 PMCID: PMC9689437 DOI: 10.3390/diagnostics12112742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 01/27/2024] Open
Abstract
Paraduodenal hernias (PDHs) represent an unusual cause of acute abdominal pain in the Emergency Department (ED) and are associated with high morbidity attributable to a challenging clinical and radiological diagnosis, as signs and symptoms mimic other frequent causes of acute abdominal pain. We report a right paraduodenal hernia in a 37-year-old female patient who presented to the ED complaining of abdominal pain located in the right lower abdomen and hypogastrium, accompanied by nausea. During diagnostic work up, the abdominal computed tomography scan revealed the presence of small bowel malrotation with concomitant right paraduodenal hernia. These findings were confirmed intraoperatively. We performed a brief literature review about the clinical manifestations and treatment options of right paraduodenal hernias, which retrieved only 30 articles related to this condition. Prompt diagnosis, radiological or intraoperative, of paraduodenal hernias is crucial because nearly 50% will progress to small bowel obstruction. Therefore, it is essential for every clinician to account for them in the differential diagnosis of acute abdominal pain in the ED.
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Affiliation(s)
- Viktoria Lamprou
- Radiology Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Despoina Krokou
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Eleni Karlafti
- Emergency Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Stavros Panidis
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Leonidas Kougias
- Department of Interventional Radiology, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Georgios Tzikos
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Aristeidis Ioannidis
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Smaro Netta
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Evanthia Thomaidou
- Department of Anesthesia and Intensive Care, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
| | - Daniel Paramythiotis
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece
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9
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Muacevic A, Adler JR, Sandhu P, Singh H, Bansal A. Paraduodenal Hernia With Massive Intestinal Gangrene and Its Surgical Management: A Case Report. Cureus 2022; 14:e32008. [PMID: 36589185 PMCID: PMC9798460 DOI: 10.7759/cureus.32008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/30/2022] Open
Abstract
Paraduonenal hernia constitutes more than 50% of internal hernia cases. It can result in perilous sequelae like gut ischemia and perforation. We report a case of a patient who presented with acute intestinal obstruction and peritonitis and was diagnosed as a case of complicated paraduodenal as an incidental finding on laparotomy. A 26-year-old male patient presented with three days history of continuous severe incapacitating diffuse abdominal pain. The pain was associated with multiple episodes of bilious vomiting and absolute constipation. Patient had signs and symptoms of shock. Abdomen examination showed generalized peritonitis. Patient had deranged laboratory investigations. Abdominal X-ray showed acute intestinal obstruction. Patient was resuscitated and taken up for emergency laparotomy. Intraoperatively there was a long segment of gangrenous small bowel entrapped in the paraduodenal sac. Gangrenous gut was released from the sac and excised with proximal and distal ends fashioned as stoma through separate sites. Patient was managed with intravenous fluids with total parental nutrition. Patient gradually started on oral diet and jejunostomy output was refed through the distal stoma. Patient was discharged on postoperative day 14. Patient had uneventful early stoma closure at postoperative day 45 and now is on regular follow-up in the outdoor department. Paraduodenal hernias are one of the rare causes of intestinal obstruction that is difficult to diagnose. Radiologic investigation like abdominal computed tomography (CT) scan can aid in diagnosis of paraduodenal hernia. Surgeons should have clear knowledge about abnormal anatomy of internal hernias and complications they can face during surgery.
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10
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Gabra A, Ageel MH. Laparoscopic treatment of pediatric paraduodenal hernia in Saudi Arabia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Gosalvez-Tejada A, Blank JJ, Flynn-O'Brien KT, Vo NN, Gourlay DM, Chugh AA. Paraduodenal Hernia: A Rare Cause of Small Bowel Obstruction. JPGN REPORTS 2022; 3:e170. [PMID: 37168754 PMCID: PMC10158419 DOI: 10.1097/pg9.0000000000000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/10/2021] [Indexed: 05/13/2023]
Affiliation(s)
- Andrea Gosalvez-Tejada
- From the Division of Pediatrics Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Jacqueline J Blank
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Katherine T Flynn-O'Brien
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Nghia N Vo
- Division of Pediatric Radiology. Department of Radiology Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - David M Gourlay
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Ankur A Chugh
- From the Division of Pediatrics Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
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12
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Somuncu E, Bozdağ E. Laparoscopic repair of the left paraduodenal hernia: A rare case of an internal hernia. ULUS TRAVMA ACIL CER 2022; 28:229-232. [PMID: 35099035 PMCID: PMC10443150 DOI: 10.14744/tjtes.2020.73232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/29/2020] [Indexed: 11/20/2022]
Abstract
Paraduodenal hernia (PDH) is a rare congenital anomaly, the most common cause of internal hernia. The left-sided PDHs (LPDHs) are more common than the right-sided and are common in male patients at the 4th and 6th years of life. LPDH is been often clinically asymptomatic and often detected by chance in surgical patients. Abdominal computed tomography is the gold standard in diagnosis. PDH can cause ischemia with the high mortality rates due to intestinal obstruction. Therefore, surgical repair should be done as soon as possible after diagnosis. Here, we present a case of LPDH that was laparoscopically diagnosed and repaired early.
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Affiliation(s)
- Erkan Somuncu
- Department of General Surgery, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul-Turkey
| | - Emre Bozdağ
- Department of General Surgery, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul-Turkey
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13
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Rohatgi Y, Harvitkar RU, Raut V, Joshi A. Broad ligament hernia: Two contrasting ways to a common goal - Two case reports with review of literature. Int J Surg Case Rep 2021; 85:106198. [PMID: 34304087 PMCID: PMC8327646 DOI: 10.1016/j.ijscr.2021.106198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Broad ligament hernia (BLH) is a rare but potentially life threatening condition. One of the two cases described here is the only reported case of BLH in recent literature, where marsupialisation was done. These two case reports comprise the only reported side by side pictorial comparison of the two laparoscopic surgical therapeutic options for BLH. Presentation of cases Both patients presented with classical symptoms and signs of acute intestinal obstruction. Imaging confirmed obstructed left BLH in case 2 and indicated a complete small bowel obstruction in case 1. Both cases were successfully managed laparoscopically. Both patients had an uneventful immediate postoperative recovery and have not had recurrence over a mean follow up period of 34.5 months. Discussion BLH is rare among all types of internal herniae. It accounts for only 4% of internal herniae and is a difficult condition to diagnose. The advent of computed tomography has increased chances of accurate preoperative diagnosis. Conclusion BLH can be successfully managed by minimally invasive surgery, even in the acute setting. When tightly entrapped bowel is unyielding; it is better not to risk injury to it by aggressive attempts at its reduction. It is safer to attempt widening of the defect into which it is entrapped, whenever feasible. Internal herniae are a rare cause of acute bowel obstruction Among internal herniae, broad ligament hernia is even more uncommon One of the two cases described in this paper is the only reported case of BLH in literature, where marsupialization was done This is the only paper with a pictorial comparison of the two contrasting ways in which this condition can be treated
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Affiliation(s)
- Yash Rohatgi
- Department of General & Laparoscopic surgery, Dr L H Hiranandani hospital, Powai, Mumbai 400076, India.
| | - Rafique Umer Harvitkar
- Department of General & Laparoscopic surgery, Dr L H Hiranandani hospital, Powai, Mumbai 400076, India
| | - Vanita Raut
- Department of Obstetrics & Gynecology, Dr L H Hiranandani hospital, Powai, Mumbai 400076, India.
| | - Abhijit Joshi
- Department of General & Laparoscopic surgery, Dr L H Hiranandani hospital, Powai, Mumbai 400076, India
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14
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Facing the unexpected: unusual causes of mechanical small bowel obstruction in adults. Clin J Gastroenterol 2021; 14:1287-1302. [PMID: 34076858 DOI: 10.1007/s12328-021-01450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
Mechanical small bowel obstruction in adults is a common emergency condition that typically requires hospitalisation and usually acute surgical intervention. The majority of the cases are due to adhesive obstruction or common abdominal wall hernias or relevant related past history. However, the surgeons might face unexpected challenges in this concept due to rare causes of this condition. This paper explores in depth the challenges encountered by the emergency general surgeons in the concept of management of rare causes of mechanical small bowel obstruction in adults through a systematic review and critical analysis of the available evidence, and summarises the essential intra-operative steps that are needed to be taken accordingly. In conclusion, the emergency surgeons should be familiar with the uncommon/rare causes of mechanical small bowel obstruction in adults to avoid serious complications. Successful outcomes are based on the combination of high index of clinical suspicion, familiarity with the standard anatomy and its variations, the use of the appropriate radiological investigations and surgical intervention in a timely manner.
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15
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Ismavel VA, Kichu M, Hechhula DP, Yanadi R. Right paraduodenal hernia with extensive bowel gangrene treated with staged surgery: a Bogota bag followed by resection in a low-resource setting. BMJ Case Rep 2021; 14:14/4/e239250. [PMID: 33910790 PMCID: PMC8094322 DOI: 10.1136/bcr-2020-239250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of right paraduodenal hernia with strangulation of almost the entire small bowel at presentation. Since resection of all bowel of doubtful viability would have resulted in too little residual length to sustain life, a Bogota bag was fashioned using transparent plastic material from an urine drainage bag and the patient monitored intensively for 18 hours. At re-laparotomy, clear demarcation lines had formed with adequate length of viable bowel (100 cm) and resection with anastomosis was done with a good outcome on follow-up, 9 months after surgery. Our description of a rare cause of strangulated intestinal obstruction and a novel method of maximising length of viable bowel is reported for its successful outcome in a low-resource setting.
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Affiliation(s)
- Vijay Anand Ismavel
- Department of Surgery, Makunda Christian Leprosy and General Hospital, Karimganj, India
| | - Moloti Kichu
- Department of General Surgery, Makunda Christian Leprosy and General Hospital, Karimganj, India
| | - David Paul Hechhula
- Department of Anesthesia, Makunda Christian Leprosy and General Hospital, Karimganj, India
| | - Rebecca Yanadi
- Department of Anatomy, Makunda Christian Leprosy and General Hospital, Karimganj, India
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16
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Udo IA, Obong V. Left Paraduodenal Hernia: A Cause of Double Intestinal Obstruction. Niger J Surg 2021; 27:78-80. [PMID: 34012249 PMCID: PMC8112357 DOI: 10.4103/njs.njs_43_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/18/2020] [Accepted: 06/05/2020] [Indexed: 11/16/2022] Open
Abstract
Paraduodenal hernias are of congenital origin and may present with symptoms and signs of small intestinal obstruction. These hernias are rare in our practice, and a definitive preoperative diagnosis is often not made as the symptoms are not specific. Early assessment and prompt and adequate resuscitation and surgery obviate the risk of strangulation and intestinal resection. This report highlights a rare cause of intestinal obstruction in a young male who presents with all the classical features of obstruction: colicky abdominal pain, distension, vomiting, and inability to pass stool or flatus. The diagnosis of paraduodenal hernia was made intraoperatively. We do not routinely request for barium examination or abdominal computed tomography scan in acute abdominal pain. These modalities can suggest a preoperative diagnosis.
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Affiliation(s)
- Isaac Assam Udo
- Department of Surgery, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Victor Obong
- Department of Surgery, University of Uyo Teaching Hospital, Uyo, Nigeria
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Vanmali A, Maharajh J, Haines M. Left paraduodenal hernia: Embryological and radiological findings. SA J Radiol 2021; 25:1979. [PMID: 33824740 PMCID: PMC8007996 DOI: 10.4102/sajr.v25i1.1979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/06/2020] [Indexed: 11/18/2022] Open
Abstract
Left paraduodenal hernia (PDH), may present as a surgical emergency with an increased risk of strangulation and incarceration. The diagnosis is challenging because of the non-specific presentation. In the absence of common epigastric or upper abdominal pathology and non-resolving symptoms, a high index of suspicion is required to diagnose left PDH. This report describes a case of radiologically diagnosed left paraduodenal hernia and subsequent successful surgery. It also includes a review of midgut embryology, and the anatomy and radiology of left PDH.
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Affiliation(s)
- Atish Vanmali
- Jackpersad and Partners Inc., Private Practice, Durban, South Africa
| | - Jaynund Maharajh
- Department of Radiology, Faculty of Medicine, King Edward VIII Hospital, Durban, South Africa
| | - Mario Haines
- Jackpersad and Partners Inc., Private Practice, Durban, South Africa
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Harvitkar RU, Joshi A. Laparoscopic Repair of Internal Hernias: a Case Series with Review of Literature. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02736-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Minilaparoscopic left paraduodenal hernia repair—a case report. Eur Surg 2020. [DOI: 10.1007/s10353-020-00640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Identification and Repair of Left-Sided Paraduodenal Hernia Using Both Laparoscopic and Robotic Techniques. Case Rep Surg 2020; 2020:7569530. [PMID: 32089943 PMCID: PMC7025034 DOI: 10.1155/2020/7569530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/07/2019] [Indexed: 12/18/2022] Open
Abstract
Internal hernias are an uncommon cause of small bowel obstruction and present a challenging clinical diagnostic scenario. They result from the abnormal protrusion of an abdominal organ through a peritoneal defect and can cause intermittent obstructive symptoms, diffuse abdominal discomfort, and postprandial pain. Paraduodenal hernias comprise 53% of all internal hernias 1 and occur due to failure of the fixation of either the left or transverse mesocolon to the posterior abdominal wall. Its relative rarity results in mortality between 20 and 50% 2 because of delayed diagnosis and consequent obstruction, strangulation, and bowel ischemia. Our case series describes three patients before and after operative fixation of paraduodenal hernia. Only one of the three was identified by preoperative radiologist interpretation. Subsequent diagnosis and definitive treatment were completed by surgical staff to resolve undiagnosed undulating abdominal pain and obstructive-type symptoms. We further analyze left-sided paraduodenal hernias after laparoscopic and robotic repair to define common symptomatology, typical CT findings, and preferred laparoscopic repair techniques.
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21
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Walkner S, Nebiker CA. Laparoscopic repair of a right-sided paraduodenal hernia. J Surg Case Rep 2019; 2019:rjz337. [PMID: 31844514 PMCID: PMC6905350 DOI: 10.1093/jscr/rjz337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/14/2019] [Indexed: 01/29/2023] Open
Abstract
With an incidence of less than 1%, paraduodenal hernias are very rare but account for ~0.2–5.8% of mechanical small bowel obstruction and carry a mortality rate of 20–50%. Right-sided paraduodenal hernias are three times less frequent than left-sided paraduodenal hernias. We report the case of a 37-year-old man who suffered from colicky abdominal pain accompanied by vomiting. The computed tomography scan showed a mechanical ileus, caused by a presumed paraduodenal hernia, and we chose an elective laparoscopic surgical approach. The patient recovered quickly and was discharged on the second postoperative day. Paraduodenal hernias are a diagnostic challenge as they are typically characterized by long-term non-specific abdominal symptoms and are only detected in the event of acute intestinal obstruction. Until now, laparoscopic therapy has only been described in eight case reports and we review this rare condition and the surgical options.
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Cho YM, Aksakal G, Ashour MAT, Moore S. Closed loop bowel obstruction secondary to left paraduodenal hernia (of Landzert). BMJ Case Rep 2019; 12:12/12/e232134. [PMID: 31811091 DOI: 10.1136/bcr-2019-232134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 34-year-old man presented with acute severe left-sided abdominal and flank pain with associated postprandial nausea and vomiting. CT imaging revealed findings suspicious for a closed loop small bowel obstruction. Intraoperative findings were that of a left paraduodenal hernia (of Landzert) secondary to a mesenteric defect immediately posterior to the ascending branch of the left colic artery. The defect was closed via minilaparotomy. Unfortunately, his postoperative course was complicated by small bowel obstruction which required further laparotomy and adhesiolysis. The patient eventually made a good recovery. Here, we present a rare case of intestinal obstruction and discuss the aetiologies and management of this unusual phenomenon.
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Affiliation(s)
- Yeo Min Cho
- Department of General Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Gamze Aksakal
- Department of General Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
| | | | - Suzanne Moore
- Department of General Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
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Abukhalaf SA, Mustafa A, Elqadi MN, Al Hammouri A, Abuzaina KNM, Abukarsh R, Ghazzawi I, Hassan S, Novotny NM. Paraduodenal hernias in children: Etiology, treatment, and outcomes of a rare but real cause of bowel obstruction. Int J Surg Case Rep 2019; 64:105-108. [PMID: 31627058 PMCID: PMC6806419 DOI: 10.1016/j.ijscr.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022] Open
Abstract
Paraduodenal Hernia has rarely been reported in the pediatric age group. Paraduodenal Hernia is a rare cause of intestinal obstruction and is often misdiagnosed. CT-scan is the gold standard mean for diagnosis in most cases. Paraduodenal Hernia must be kept in mind as a possible cause of intestinal obstruction.
Introduction Paraduodenal Hernia (PDH) is the most common variant of internal hernia and occurs most often in males during their 4th–6th decades of life. PDH in pediatric age group has rarely been reported in literature with only five cases of age up to 10 years were reported. PDH is a rare cause of intestinal obstruction, which may lead to subsequent strangulation and perforation of the bowel. Presentation of case We reported a 1.5 year-old male child presented with intestinal obstruction. The patient experienced abdominal pain, vomiting and irritability. Abdominal x-ray showed distal intestinal obstruction which was discovered to be a result of left PDH incidentally during the surgery. In addition, we performed a literature search using PubMed to identify the published cases of PDH. We also compared our case with the characteristics of all reported PDHs in toddlers and children up to 10 years of age in a concise table. Discussion Despite its congenital origin, PDH has been reported in childhood age group in very rare occasions rendering the accurate incidence of PDH in infancy and childhood unknown. PDHs can be asymptomatic or can present most commonly with recurrent upper abdominal pain. Diagnosis is quite difficult in the absence of symptoms but could be achieved using a computed tomography (CT-scan) in non-emergency symptomatic patients. Surgical repair is mandatory to avoid potential complications. Conclusion As PDH can lead to major and life threatening complications, it must remain in our minds as a possible cause of intestinal obstruction.
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Affiliation(s)
| | - Aya Mustafa
- Yarmouk University, Faculty of Medicine, Irbid, Jordan.
| | | | | | | | | | - Ihsan Ghazzawi
- Palestine Red Crescent Society Hospital, Hebron, Palestine.
| | - Shareef Hassan
- Palestine Red Crescent Society Hospital, Hebron, Palestine.
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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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Lanzetta MM, Masserelli A, Addeo G, Cozzi D, Maggialetti N, Danti G, Bartolini L, Pradella S, Giovagnoni A, Miele V. Internal hernias: a difficult diagnostic challenge. Review of CT signs and clinical findings. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:20-37. [PMID: 31085971 PMCID: PMC6625567 DOI: 10.23750/abm.v90i5-s.8344] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Indexed: 12/16/2022]
Abstract
Although internal hernias are uncommon, they must be beared in mind in the differential diagnosis in cases of intestinal obstruction, especially in patients with no history of previous surgery or trauma. Because of the high possibility of strangulation and ischemia of the affected loops, internal hernias represent a potentially life-threatening condition and surgical emergency that needs to be quickly recognized and managed promptly. Imaging plays a leading role in the diagnosis and in particular multidetector computed tomography (MDCT), with its thin-section and high-resolution multiplanar reformatted (MPR) images, represents the first line image technique in these patients. The purpose of the present paper is to illustrate the characteristic anatomic location, the clinical findings and the CT appearance associated with main types of internal hernia, including paraduodenal, foramen of Winslow, pericecal, sigmoid-mesocolon- and trans-mesenteric-related, transomental, supravesical and pelvic hernias. (www.actabiomedica.it)
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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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