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CC BY 4.0 · Surg J (N Y) 2021; 07(03): e212-e215
DOI: 10.1055/s-0041-1733989
Case Report

Left Paraduodenal Hernia Presenting as Closed Loop Jejunal Obstruction in a Young Female: An Enigmatic and Perilous Differential of Acute Abdomen

Deepak Rajput 
1   Department of General Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
,
Ankit Rai 
1   Department of General Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
,
Amit Gupta 
1   Department of General Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
,
Subramanian Chezhian 
1   Department of General Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
,
Shashank Kumar 
1   Department of General Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
,
Ashikesh Kundal 
1   Department of General Surgery, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
› Author Affiliations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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Abstract

Internal hernia is a rare cause of intestinal obstruction, accounting for <2% of cases with paraduodenal type being the most common. An internal hernia, mostly acquired, develops due to protuberance of the intestine through a gap in the peritoneum or mesentery formed as a result of an antecedent abdominal operation such as gastric bypass or liver transplant, ischemic injury, peritonitis, or trauma. Paraduodenal hernias (PDHs) are congenital anomalies, secondary to a failed fusion of mesentery with parietal peritoneum along with rotational midgut errors, causing the evolution of potential space for herniation within the left paraduodenal fossa. Primary internal hernias can have a varied clinical presentation and cause significant mortality and morbidity if left untreated. We report the case of a 20-year-old female with chronic pain in abdomen and intestinal obstruction due to left PDH (LPDH). The prompt diagnosis led to timely exploration and reduction of entrapped jejunum, with prudent closure of the hiatus, while circumventing any injury to the adjacent mesenteric circulation. No postoperative ileus arose, and recovery was uneventful.

Keywords

closed-loop obstruction - small bowel obstruction - paraduodenal hernia - chronic pain abdomen - internal hernia

Informed Consent

Written informed consent was obtained from the patient for her anonymized information to be published in this article.




Publication History

Received: 11 September 2020

Accepted: 11 June 2021

Article published online:
01 September 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Newsom BD, Kukora JS. Congenital and acquired internal hernias: unusual causes of small bowel obstruction. Am J Surg 1986; 152 (03) 279-285
    CrossrefPubMedGoogle Scholar
  • 2 Meyers MA, Baker SR, Berne AS. et al. Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy. New York, NY: Springer-Verlag; 2000
    Google Scholar
  • 3 Armstrong O, Hamel A, Grignon B. et al. Internal hernias: anatomical basis and clinical relevance. Surg Radiol Anat 2007; 29 (04) 333-337
    CrossrefPubMedGoogle Scholar
  • 4 Brigham RA, Fallon WF, Saunders JR, Harmon JW, d'Avis JC. Paraduodenal hernia: diagnosis and surgical management. Surgery 1984; 96 (03) 498-502
    PubMedGoogle Scholar
  • 5 Khan MA, Lo AY, Vande Maele DM. Paraduodenal hernia. Am Surg 1998; 64 (12) 1218-1222
    PubMedGoogle Scholar
  • 6 Jay Satapara, Nandini Bahri, Sneha Chaudhari. Left paraduodenal hernia – why herniate outside when you can do the same inside. Accessed June 24, 2021 at: https://www.eurorad.org/case/16516
    PubMedGoogle Scholar
  • 7 Al Otaibi RS, Al Maghrabi HS, Bin Dous Y, Malaekah H. A rare case of small bowel obstruction due to paraduodenal hernia. Am J Case Rep 2019; 20: 1581-1586
    CrossrefPubMedGoogle Scholar
  • 8 Kozman MA, Fisher OM. Left paraduodenal hernia: a rare complication following laparoscopic appendectomy. Case Rep Surg 2017; 2017: 3913784
    PubMedGoogle Scholar
  • 9 Blachar A, Federle MP, Brancatelli G, Peterson MS, Oliver III JH, Li W. Radiologist performance in the diagnosis of internal hernia by using specific CT findings with emphasis on transmesenteric hernia. Radiology 2001; 221 (02) 422-428
    CrossrefPubMedGoogle Scholar
  • 10 Takeyama N, Gokan T, Ohgiya Y. et al. CT of internal hernias. Radiographics 2005; 25 (04) 997-1015
    CrossrefPubMedGoogle Scholar
  • 11 Manji R, Warnock GL. Left paraduodenal hernia: an unusual cause of small-bowel obstruction. Can J Surg 2001; 44 (06) 455-457
    PubMedGoogle Scholar
  • 12 Kurachi K, Nakamura T, Hayashi T. et al. Left paraduodenal hernia in an adult complicated by ascending colon cancer: a case report. World J Gastroenterol 2006; 12 (11) 1795-1797
    CrossrefPubMedGoogle Scholar
  • 13 Jeong GA, Cho GS, Kim HC, Shin EJ, Song OP. Laparoscopic repair of paraduodenal hernia: comparison with conventional open repair. Surg Laparosc Endosc Percutan Tech 2008; 18 (06) 611-615
    CrossrefPubMedGoogle Scholar