Abnormal location of small bowel loops within the left hemiabdomen, lying in the left anterior pararenal space. Paraduodenal hernia pdh represents rare clinical entities based on few literatures. Ct is the imaging modality of choice in diagnosing a paraduodenal hernia. Laparoscopic paraduodenal hernia repair sages abstract. Webmd explains the symptoms of hernias and when to seek medical care images for hernia right side. Paraduodenal hernias are rare congenital internal hernias accounting for a case report r. Medical records, including mdct images and intraoperative findings. Gastrointestinal imaging 88 internal hernias in the era of multidetector ct.
Paraduodenal hernias arise from a deficiency in midgut rotation. Diagnosis of pdh was based on either radiological imaging or intraoperative surgical findings. Lack of specific diagnostic criteria also makes diagnosis exceedingly difficult, and the resulting diagnostic delays can lead to tragic outcomes for patients. The paraduodenal hernia is a congenital internal hernia that occurs through an mesenteric defect there are 2 types of paraduodenal hernia. Clinical features of paraduodenal hernia yu jun wong, narayan. Doctors give unbiased, trusted information on the use of imaging for hiatal hernia. Internal hernias remain one of the most challenging and potentially frustrating diagnoses that face abdominal imagers. Pdf laparoscopic repair of a right paraduodenal hernia. Paraduodenal herniact wednesday, july 22, 2009 ct, duodenum, git, hernia, radiology intestinal obstruction is a common clinical condition that is usually suspected on the basis of clinical signs and patient history. Ct findings include a zone of transition depicting a change in diameter of small bowel from dilated to a normal or decreased diameter such as the pinch point seen in the.
Although it may be an incidental finding at autopsy or at laparotomy, some cases are symptomatic. Laparoscopic repair is reasonable in patients who have a. Paraduodenal hernias, which are a type of internal hernia, occur due to malrotation of midgut and form a potential space near the ligament of treitz. We report five cases of paraduodenal hernia, all occurring in male patients ranging from 34 to 75 years of age. Paraduodenal hernia pdh is defined as abnormal herniation of the small bowel into the paraduodenal fossa. Ge junction in normal position under diaphragm, fundus in.
By using a bolustracking program, arterial phase scanning was. Paraduodenal hernias are the commonest type of internal hernia, affecting 23% of the population. This is a retrospective case series of pdh diagnosed in singapore general hospital sgh. In such a condition, imaging is mandatory for the diagnosis. Vasudevan, md paraduodenal hernias are the most common type of congenital internal hernia. Internal hernias, including paraduodenal traditionally the most common, pericecal, foramen of winslow, and intersigmoid hernias, account for approximately 0. A case of strangulated ileus caused by intramesosigmoid hernia with left paraduodenal hernia nihon rinsho geka gakkai zasshi journal of japan surgical association, vol. Diagnosis of pdh was based on radiological or intraoperative surgical findings. Associated stretching and distortion of mesenteric vessels. N2 an internal hernia is the protrusion of a viscus through a normal or abnormal opening within the confines of the abdominal cavity. Congenital left paraduodenal hernia causing chronic. The majority of presentations occur between the 4th and 5th decades of life.
Clinical and imaging findings in 17 patients with emphasis on ct criteria. Clinical features of paraduodenal hernia yu jun wong. Recently, laparoscopic surgery has been increasingly performed in abdominal procedures. Friday exhibit hall video presentations session 1 held during the 2017 sages annual meeting in houston, tx on friday, march 24, 2017.
Incidental finding at laparotomy or on imaging is the most common presentation of. Paraduodenal hernia is a congenital internal hernia caused by abnormal retroperitoneal fixation of the intestinal mesentery. Internal hernia is, either congenital or acquired, a rare cause of smallbowel obstruction, with a reported incidence of less than 2%. Pdf right paraduodenal hernia pdh results from a primitive gut malrotation. Right paraduodenal hernia an imaging diagnosis eurorad. Paraduodenal hernia is a rare congenital malformation. Paraduodenal hernias are very rare, but they account for about 30%53% of all internal hernias. Usually, total or subtotal internal herniation of the small bowel loops is recognized readily, but insufficient attention has been given to the frequency and clinical significance of small paraduodenal hernias. An internal hernia is defined as a hernia formed by the protrusion of a viscus through a peritoneal or mesenteric aperture, leading to its encapsulation within a compartment of the abdominal cavity.
Internal hernia ihrelated surgical acute abdomen is not well understood. Paraduodenal hernias, although uncommon, have classically been the most common type of internal hernia. Paraduodenal hernia, mesocolic hernia, internal hernia, intestinal malrotation, embryology, small bowel obstruction, gastrointestinal radiology. One such hernia is paraduodenal hernia which can be either on the left or right of the duodenum and occurs through an unusual peritoneal recess into the retroperitoneum. The history and physical examination are usually sufficient to make the diagnosis. A hernia is a protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it. P araduodenal hernia, also called mesocolic hernia, is a type of internal hernia that is thought to be caused by a congenital defect involving abnormal retroperitoneal fixation of the mesentery due to abnormal rotation of the midgut.
In the right paraduodenal hernia the major findings consist of encapsulation of small bowel loops in the right midabdomen with looping of arterial and venous jejunal branches behind the superior mesenteric artery. The management of paraduodenal hernia consists of reduction of the herniated intestine and repair of the defect. Internal hernias in the era of multidetector ct rsna publications. Once the weakened area becomes large enough, a part of the internal organ starts. What is a hernia ultrasound a hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it. An enlarged inguinal lymph node can mimic an incarcerated inguinal hernia, and surgical exploration may occasionally be necessary to confirm the diagnosis. Imaging ct abdomen and pelvis is a good imaging modality to assess for abdominal hernia, especially when there is concern for acute incarceration or strangulation. Correlation of imaging and surgical findings1 clinical diagnosis of internal hernias is challenging because of their nonspecific signs and symptoms.
Most abdominal wall hernias should be evaluated by a surgeon when identified. When presentation and examination suggest a diagnosis other than hernia or hydrocele, appropriate imaging, including ultrasonography, may be necessary. A ct scan of a left paraduodenal hernia usually demonstrates clustering of loops of small bowel at or above the ligament of treitz or behind the stomach, causing a mass effect on the posterior wall. Findings are consistent with left paraduodenal hernia. An internal hernia ih is defined as the protrusion of abdominal viscera, most. Classic ct features include an encapsulated cluster of small bowel loops located between the pancreatic bodytail and the stomach. The computed tomographic ct findings of a right and left paraduodenal hernia are described. Early reports utilizing ct in diagnosing internal hernia started almost at. However, the incidence of postoperative internal hernias has been increasing recently. How to check for a hernias happens when an area of the muscle wall holding your internal organs in place becomes weakened. Preoperative diagnosis of right paraduodenal hernia by.
Gastroesophageal ge junction and gastric cardia pass through esophageal hiatus paraesophageal rolling hernia. Importance of subject although internal hernias have an overall incidence of less than 1%, they constitute up to 5. Inguinal hernias are one of the most common reasons a primary care patient may need referral for surgical intervention. Proper repair of right paraduodenal hernia has been described by bartlett et al. By using a bolustracking program, arterial phase scanning was started.
The outer confines of the hernia sac are well defined. Clinical features of paraduodenal hernia yu jun wong, narayan lath, alvin kim hock eng, and vikneswaran navasivayam proceedings of singapore healthcare 2017 27. It is most commonly observed in the abdomen but can also occur in the upper thigh, belly button, and groin. Congenital left paraduodenal hernia causing chronic abdominal pain and abdominal catastrophe yan shi, md a,b, amy e. Overview of abdominal wall hernias in adults uptodate. Because of its overall rare incidence, this entity is often overlooked during initial assessment of the patient. The patients had varied manifestations presenting with abdominal pain with or without vomiting and nausea and with or without signs of intestinal obstruction. Symptomatic patients often have groin pain, which can sometimes be severe. Paraduodenal hernias pdh, also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0. Abdominal wall hernias are usually suggested by the patients history and confirmed by physical examination. Paraduodenal hernia pdh, though uncommon, is a surgical emergency associated with high risk of strangulation and incarceration. Paraduodenal hernias frequently present subtle findings on barium contrast studies. To evaluate the feasibility and efficacy of laparoscopic. The nature of the repair depends upon the size and location of the.
In the clinical literature, only a few cases of paraduodenal hernia diagnosed with computed tomography ct have been reported. Although most abdominal hernias are asymptomatic, the fear of developing complications like. Herniation of the small bowel through the paraduodenal mesenteric fossa of landzert. The two most common types, the left and right paraduodenal hernia involve small bowel herniating through a congenital opening in the mesenteries. Laparoscopic repair of a right paraduodenal hernia ncbi. Eight pdhs were identified during the study period. The hernia ultrasound is a noninvasive diagnostic exam that captures images of the major structures involved in the hernia. However, unlike malrotation, the duodenum crosses the midline and the cecum is located in the right lower quadrant. The ectopic small bowel is contained within a hernia sac, which is outlined by ascites. The herniated bowel exerts mass effect on the greater curvature of the stomach, characteristic of a left paraduodenal hernia. Right small bowel followthrough demonstrates an ovoid cluster of mildly dilated jejunal segments in the left upper quadrant.
1063 1158 1370 94 1282 1064 923 573 802 842 443 1176 1204 1370 391 1178 421 699 730 1016 234 13 1458 67 1289 936 689 889 844 860