Abstract
Background
Paraduodenal hernias are the most common form of internal hernias. There are few reports in the literature, with the total number of reported cases being less than 500. We report four patients with paraduodenal hernias causing intestinal obstruction.
Materials and methods
All of the four patients with paraduodenal hernias presented with features of intestinal obstruction. A clinical diagnosis was not made in any of the cases, and computed tomography (CT) scanning was performed to confirm this. They were all successfully managed by a laparoscopic repair.
Results
The operating time was 55–72 mins. Postoperatively, three patients recovered uneventfully, while one patient had ileus for 3 days and, thereafter, recovered spontaneously. Hospital stay was in the range 2–6 days. There were no conversions. One patient had recurrent paraduodenal hernia, for which a laparoscopic mesh repair was successfully performed.
Discussion
The mechanism of the herniation is thought to be a defective rotation of the superior mesenteric vein during embryonic development. Paraduodenal hernias are not high on the list of differentials for bowel obstruction. Some form of surgery is mandatory for all cases. The inferior mesenteric vein has to be sacrificed in some cases to facilitate reduction of the hernia contents. A mesh repair is reserved for large defects and recurrent hernias. Laparoscopic repair has been infrequently reported in the literature. Based on our experience, the laparoscopic approach seems to be effective in the repair of paraduodenal hernias. It carries all of the benefits of minimal access surgery, while providing a sound repair.
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References
Yoo HY, Mergelas J, Seibert DG (2000) Paraduodenal hernia: a treatable cause of upper gastrointestinal tract symptoms. J Clin Gastroenterol 31:226–229
Tong RSK, Sengupta S, Tjandra JJ (2002) Left paraduodenal hernia: case report and review of the literature. ANZ J Surg 72:69–71
Pershad J, Simmons GT, Chung D, Frye T, Marques MB (1998) Two acute pediatric abdominal catastrophes from strangulated left paraduodenal hernias. Pediatr Emerg Care 14:347–349
Finck CM, Barker S, Simon H, Marx W (2000) A novel diagnosis of left paraduodenal hernia through laparoscopy. Surg Endosc 14:87
Uematsu T, Kitamura H, Iwase M, Yamashita K, Ogura H, Nakamuka T, Oguri H (1998) Laparoscopic repair of a paraduodenal hernia. Surg Endosc 12:50–52
Huang YC, Chen HL, Hsu WM, Chen SJ, Lai MW, Chang MH (2001) Left paraduodenal hernia presenting as intestinal obstruction: report of one case. Acta Paediatr Taiwan 42:172–174
Khan MA, Lo AY, Van de Maele DM (1998) Paraduodenal hernia. Am Surg 64:1218–1222
McDonagh T, Jelinek GA (1996) Two cases of paraduodenal hernia, a rare internal hernia. J Accid Emerg Med 13(1):64–68
Patterson JA, Tadros EG, Wilkinson AJ (2001) An unusual case of left paraduodenal hernia. Int J Clin Pract 55:649
Meeussen C, Huyghe M, Deckers E (2006) Paraduodenal hernia evoking intermittent abdominal pain. Acta Chir Belg 106:211–214
Suchato C, Pekanan P, Panjapiyakul C (1996) CT findings in symptomatic left paraduodenal hernia. Abdom Imaging 21(2):148–149
Cingi A, Demirkalem P, Manukyan MN, Tuney D, Yegen C (2006) Left-sided paraduodenal hernia: report of a case. Surg Today 36(7):651–654
Dritsas ER, Ruiz OR, Kennedy GM, Blackford J, Hasl D (2001) Paraduodenal hernia: a report of two cases. Am Surg 67:733–736
Brunner WC, Sierra R, Dunne JB, Simmang CL, Scott DJ (2004) Incidental paraduodenal hernia found during laparoscopic colectomy. Hernia 8(3):268–270
Rollins MD, Glasgow RE (2004) Left paraduodenal hernia. J Am Coll Surg 198:492–493
Moon CH, Chung MH, Lin KM (2006) Diagnostic laparoscopy and laparoscopic repair of a left paraduodenal hernia can shorten hospital stay. JSLS 10(1):90–93
Michihiro Y, Tetsuya M, Hiroshi T, Ryoji T, Shingo S (2005) A case of left paraduodenal hernia diagnosed preoperatively and treated by laparoscopy-assisted surgery. J Jpn Surg Assoc 66(9):2173–2176
Chikashi N, Kazuhiro M, Hiroshi M, Fumihiro K, Ryuichi Y, Hideyuki Y, Kenji N (2002) Two cases of left paraduodenal hernia. Laparotomy and laparoscopic repair. J Jpn Surg Assoc 63(5):1302–1307
Antedomenico E, Singh NN, Zagorski SM, Dwyerk K, Chung MH (2004) Laparoscopic repair of a right paraduodenal hernia. Surg Endosc 18:165–166
Fukunaga M, Kidokoro A, Iba T, Sugiyama K, Fukunaga T, Nagakari K, Suda M, Yosikawa S (2004) Laparoscopic surgery for left paraduodenal hernia. J Laparoendosc Adv Surg Tech A 14(2):111–115
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Palanivelu, C., Rangarajan, M., Jategaonkar, P.A. et al. Laparoscopic management of paraduodenal hernias: mesh and mesh-less repairs. A report of four cases. Hernia 12, 649–653 (2008). https://doi.org/10.1007/s10029-008-0376-y
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DOI: https://doi.org/10.1007/s10029-008-0376-y