Small bowel obstruction secondary to left paraduodenal hernia: A case report and literature review. (2018)

• Record Type: Journal Article
• Authors: Sleiman, Youssef; El-Kheir, Alaa; El-Khoury, Melody; Hamdach, Omar; Ismail, Layla; Allouch, Mustafa
• Is Part Of: International journal of surgery case reports. Volume 53(2018)
• Page Start: 29
• Page End: 31
• Publication Date: 2018
• Subjects: CIH congenital internal hernia -- LPDH left paraduodenal hernia -- SBO small bowel obstruction -- CT computed tomography -- IMV inferior mesenteric vein; Internal hernia -- Left paraduodenal hernia -- Landzert fossa -- Intestinal obstruction; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2018.10.018
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: 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. Abstract: 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.