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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hasegawa N, Takeyama H, Suzuki Y, Noura S, Odagiri K, Yanagimoto Y, Yamashita M, Shimizu J, Kawase T, Imamura H, Iwazawa T, Tomita N, Dono K. Left paraduodenal hernia treated by single-incision laparoscopic surgery: a case report. Surg Case Rep 2021; 7:213. [PMID: 34546429 PMCID: PMC8455758 DOI: 10.1186/s40792-021-01292-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Paraduodenal hernia is a rare internal hernia which accounts for only 1% of all intestinal hernias. There have been limited reported cases of paraduodenal hernia treated by laparoscopic surgery. We report a case of left paraduodenal hernia that was successfully treated by single-incision laparoscopic surgery (SILS). Case presentation A 17-year-old woman presented with left upper abdominal pain. An abdominal enhanced multi-detector computed tomography demonstrated encapsulated cluster of small bowel loops in the left upper quadrant which passed through the dorsal side of the inferior mesenteric vein, and showed that blood flow of the prolapsed small bowel was preserved. We preoperatively diagnosed left paraduodenal hernia without ischemia or necrosis. We performed elective SILS because she was a young actress training school student and cosmetic benefit was thought to be important. We pulled out the protruded small bowel and closed a defect with a running suture by SILS. The patient was discharged 3 days after the surgery with no complications. Conclusions We reported the case of left paraduodenal hernia successfully diagnosed and treated by SILS.
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Affiliation(s)
- Noboru Hasegawa
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Hiroshi Takeyama
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan.
| | - Yozo Suzuki
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Shingo Noura
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Kazuki Odagiri
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Yoshitomo Yanagimoto
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Masafumi Yamashita
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Junzo Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Tomono Kawase
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Takashi Iwazawa
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Naohiro Tomita
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Keizo Dono
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
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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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Sleiman Y, El-Kheir A, El-Khoury M, Hamdach O, Ismail L, Allouch M. Small bowel obstruction secondary to left paraduodenal hernia: A case report and literature review. Int J Surg Case Rep 2018; 53:29-31. [PMID: 30366174 PMCID: PMC6205147 DOI: 10.1016/j.ijscr.2018.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/26/2018] [Accepted: 10/06/2018] [Indexed: 11/13/2022] Open
Abstract
Congenital 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.
Introduction Internal hernias are uncommon and are defined by the protrusion of a viscus through intraperitoneal defects. Left paraduodenal hernias (LPDH) are the most common type of congenital internal hernia (CIH). We report a clinical case of a patient with a small bowel obstruction (SBO) due to a LPDH. Case presentation An elderly patient, with negative surgical history, presented to the emergency room with abdominal pain and vomiting. Clinical and radiologic investigations were consistent with SBO due to an internal hernia. During laparotomy, a large LPDH containing dilated small bowel loops was identified. The hernia contents were reduced and the opening was closed with non-absorbable sutures. The post-operative course was uneventful without signs of recurrence at follow up. Discussion LPDH result from absence of retroperitoneal fixation of the descending colon mesentery. Usually, patients are asymptomatic and LPDH are incidental findings detected on imaging and/or during laparotomy. However, LPDH may lead to acute SBO therefore a high index of clinical suspicion and preoperative imaging is crucial to make an early diagnosis. Conclusion CIH is a rare condition due to embryologic developmental abnormalities. Their diagnosis is based on pathognomonic findings on computed tomography scanner (CTscan). Surgical treatment is the mainstay treatment. Delay diagnosis of strangulated CIH is associated with significant morbidity andmortality.
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Affiliation(s)
- Youssef Sleiman
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Lebanon; Department of General and Digestive Surgery, Nini Hospital, Tripoli, Lebanon.
| | - Alaa El-Kheir
- Department of General and Digestive Surgery, Nini Hospital, Tripoli, Lebanon
| | - Melody El-Khoury
- Department of General and Digestive Surgery, Nini Hospital, Tripoli, Lebanon
| | - Omar Hamdach
- Department of General and Digestive Surgery, Nini Hospital, Tripoli, Lebanon
| | - Layla Ismail
- Department of Radiology, Nini Hospital, Tripoli, Lebanon
| | - Mustafa Allouch
- Department of General and Digestive Surgery, Nini Hospital, Tripoli, Lebanon
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Abstract
Left paraduodenal hernia is an entrapment of the small bowel into the Landzert fossa, an unusual congenital peritoneal defect behind the descending mesocolon that results from failure of part of the descending mesocolon to fuse with the posterior parietal peritoneum (Doishita et al. in Radiographics, 36(1): 88-106, 2016). This fossa is reported to be present in approximately 2% of autopsy bodies. The authors present a case of a left paraduodenal hernia in a young woman.
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Zizzo M, Smerieri N, Barbieri I, Lanaia A, Bonilauri S. Laparoscopic treatment of acute small bowel obstruction due to left paraduodenal hernia: A case report and literature review. Int J Surg Case Rep 2016; 20:87-91. [PMID: 26826933 PMCID: PMC4818316 DOI: 10.1016/j.ijscr.2016.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/13/2016] [Accepted: 01/16/2016] [Indexed: 11/12/2022] Open
Abstract
Left paraduodenal hernia is a potentially severe cause of small bowel obstruction. Abdominal computed tomography scan is the standard for a correct diagnosis. Laparoscopy is feasible and effective, also in emergency situation.
Introduction Internal hernia is a pathological condition resulting from abnormal protrusion of abdominal viscera through an opening in the intraperitoneal recesses of the abdominal cavity. Small bowel obstruction due to internal hernia is not common (0.25–0.9% of cases). The most common group is that of paraduodenal hernias (53%), of which the left-sided one is the most common type (75%). Presentation of case We report a case of a 43 year-old man with a history of recurrent abdominal pain, who was hospitalized because of an episode of acute small bowel obstruction. He had no previous surgery. Computed tomography revealed an encapsulated circumscribed cluster of jejunal loops in the left upper quadrant, near the ligament of Treitz, and the hernia orifice was adjacent to the left side of the inferior mesenteric vessels. Emergency laparoscopic surgery was performed: the small bowel was found completely herniated under the inferior mesenteric vessels. It was gradually reduced and the hernia space was closed with a running suture. The patient was discharged on the fourth day without complications. Conclusion Left paraduodenal hernia is a rare cause of small bowel obstruction that should be taken into account in a patient with a history of recurrent abdominal pain or intestinal obstruction, and no previous surgery. Computed tomography is the standard for a correct diagnosis. Surgery is treatment of choice, because it reduces the risk of emergency and complications associated to hernia. Laparoscopic approach is feasible and effective, also in emergency situation.
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Affiliation(s)
- Maurizio Zizzo
- Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera-IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Nazareno Smerieri
- Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera-IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Italo Barbieri
- Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera-IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Andrea Lanaia
- Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera-IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Stefano Bonilauri
- Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera-IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy.
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Gerdes C, Akkermann O, Krüger V, Gerdes A, Gerdes B. Incarceration of Meckel's diverticulum in a left paraduodenal Treitz' hernia. World J Clin Cases 2015; 3:732-735. [PMID: 26301234 PMCID: PMC4539413 DOI: 10.12998/wjcc.v3.i8.732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/16/2015] [Accepted: 07/09/2015] [Indexed: 02/05/2023] Open
Abstract
Meckel’s diverticula incarcerated in a hernia were first described anecdotally by Littré, a French surgeon, in 1700. Meckel, a German anatomist and surgeon, explained the pathophysiology of this disease 100 years later. In addition, a congenital paraduodenal mesocolic hernia, known as a Treitz hernia, is a rare cause of small bowel obstruction. These hernias are caused by an abnormal rotation of the primitive midgut, resulting in a right or left paraduodenal hernia. We treated a patient presenting with pain and diagnosed extraluminal air in the abdomen after a computed tomography examination. We performed a laparotomy and found a combination of these two seldomly occurring congenital diseases, incarceration and perforation of Meckel’s diverticulum in a left paraduodenal hernia. We performed a thorough review of the literature, and this report is the first to describe a patient with a combination of these two rare conditions. We considered the case regarding the variety of terminology as well as the treatment options of these conditions.
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Torcivia A, Genser L, Siksik JM. Left paraduodenal hernia in an adult obese patient at the time of bariatric surgery. Surg Obes Relat Dis 2013; 9:e66-8. [PMID: 23453727 DOI: 10.1016/j.soard.2013.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 01/18/2013] [Accepted: 01/18/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Adriana Torcivia
- Department of Digestive and Hepato-Pancreato-Biliary Surgery Assistance, Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, University Institute of Cancerology (Paris VI), Pierre & Marie Curie University, Institute of Cardiology Metabolism and Nutrition (ICAN), Paris, France.
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