A Case of Intrauterine Right Paraduodenal Hernia into the Fossa of Waldeyer with Neonatal Death

Introduction

Skandalakis JE et al. described five paraduodenal fossae located in the posterior abdominal wall ([Fig. 1]), which may have clinical importance for the development of a paraduodenal hernia. With a relative incidence of 1 %, the mesenteric parietal fossa of Waldeyer is the most uncommon. This is the peritoneal recess behind the duodenal fold into which the bowel slipped in the reported case. Its sac is to the right and the mouth is behind the superior mesenteric artery and opens to the left. The origin of the paraduodenal fossa is congenital and results from abnormal embryologic development. Around the 6^th week, the midgut starts its 270° rotation around the superior mesenteric artery. If the pre-arterial segment rotates but the post-arterial segment does not, the small bowel is trapped in the right mesocolon and right paraduodenal hernia results (Manji R et al. Can J Surg 2001; 44: 455 – 457).

Fig. 1 Scope of herniations of small bowel in paraduodenal fossae: 1 – superior duodenal fossa of Treitz; 2– paraduodenal fossa of Landzert; 3 – inferior duodenal fossa of Treitz; 4 – intermesocolic fossa of Bröesike; 5 – mesentericoparietal fossa of Waldeyer.

Abb. 1 Möglichkeiten der Dünndarmherniation in folgende Fossae paraduodenales: 1 – obere duodenale Fossa nach Treitz; 2 – paraduodenale Fossa nach Landzert; 3 – untere duodenale Fossa nach Treitz; 4 – intermesocolische Fossa nach Bröesike; 5 – mesentericoparietale Fossa nach Waldeyer.

Right paraduodenal hernia is described in a textbook for pediatric surgeons (Skandalakis JE et al. Embryology for Surgeons 1972; 2: 113 – 149). However, a Pubmed search did not reveal any cases in a newborn or a fetus. Its etiology is supposed to be congenital but diagnosis is usually made in young adulthood (Dassinger MS et al. JSLS 2007; 11: 266 – 267). A right paraduodenal hernia may lead to nausea, bilious vomiting, intestinal obstruction and right upper quadrant pain of varying intensity (Yoo HY et al. J Clin Gastroenterol 2001; 31: 226 – 229).