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Left paraduodenal hernia presenting with atypical symptoms.

Yun MY, Choi YM, Choi SK, Kim SJ, Ahn SI, Kim KR - Yonsei Med. J. (2010)

Bottom Line: Paraduodenal hernias are a rare congenital malformation, but they are the most common internal hernias.They develop secondary to a failure in midgut rotation, which may lead to small bowel obstruction or other clinical manifestations.The authors recently experienced a case of a left paraduodenal hernia presenting with unusual symptoms of left flank pain and vomiting.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, College of Medicine, Inha University, Incheon, Korea.

ABSTRACT
Paraduodenal hernias are a rare congenital malformation, but they are the most common internal hernias. They develop secondary to a failure in midgut rotation, which may lead to small bowel obstruction or other clinical manifestations. The authors recently experienced a case of a left paraduodenal hernia presenting with unusual symptoms of left flank pain and vomiting.

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Related in: MedlinePlus

Intraoperative view from the root of the transverse mesocolon reveals the hernia orifice (narrow arrow) through which the small bowel (SB) herniated.
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Figure 3: Intraoperative view from the root of the transverse mesocolon reveals the hernia orifice (narrow arrow) through which the small bowel (SB) herniated.

Mentions: A 38-year-old man presented to the emergency department complaining of left flank pain and vomiting. He could not stay in a supine position because of flank pain. He had no remarkable medical history. Specifically, he had no history of abdominal surgery. A physical examination revealed a slightly distended abdomen and left costovertebral angle tenderness. Blood analysis, urine analysis, and a plain abdominal radiography showed no abnormalities, except for leukocytosis of 11,200 cells/mL. Abdominal ultrasonography showed mild left hydronephrosis with no ureteral obstruction. His pain was initially thought to be caused by acute pyelonephritis. Over the few hours following admission, the patient complained of increased left flank pain and vomiting. Computed tomography showed a cluster of small bowel loops encased in a sac located amidst the stomach, the pancreas, and the left kidney, the latter of which was normal without hydronephrosis (Fig. 1). The diagnosis of a left paraduodenal hernia was made using an upper gastrointestinal series with small bowel follow-through, which revealed loops of jejunum clumping over the left upper quadrant of the abdomen (Fig. 2A). These loops were identified in the posterior wall of the stomach (Fig. 2B). With the patient's left flank pain progressively worsening, a laparotomy was performed via a midline incision. Exploration revealed that about one third of the proximal small bowel was encapsulated in a peritoneal sac formed by a peritoneal flap of the left mesentery. The orifice of the hernia sac was located below the inferior mesenteric vein, with engorgement and crowding (Fig. 3). The small bowel was viable and was easily reduced after herniotomy. The defects in the left mesocolon and the hernia orifice were closed. Further inspection of the peritoneal cavity revealed no other abnormality. Postoperatively, the patient had an uneventful recovery and was discharged on postoperative day 5. During the follow-up period of 1 year, he remained completely free of symptoms.


Left paraduodenal hernia presenting with atypical symptoms.

Yun MY, Choi YM, Choi SK, Kim SJ, Ahn SI, Kim KR - Yonsei Med. J. (2010)

Intraoperative view from the root of the transverse mesocolon reveals the hernia orifice (narrow arrow) through which the small bowel (SB) herniated.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908883&req=5

Figure 3: Intraoperative view from the root of the transverse mesocolon reveals the hernia orifice (narrow arrow) through which the small bowel (SB) herniated.
Mentions: A 38-year-old man presented to the emergency department complaining of left flank pain and vomiting. He could not stay in a supine position because of flank pain. He had no remarkable medical history. Specifically, he had no history of abdominal surgery. A physical examination revealed a slightly distended abdomen and left costovertebral angle tenderness. Blood analysis, urine analysis, and a plain abdominal radiography showed no abnormalities, except for leukocytosis of 11,200 cells/mL. Abdominal ultrasonography showed mild left hydronephrosis with no ureteral obstruction. His pain was initially thought to be caused by acute pyelonephritis. Over the few hours following admission, the patient complained of increased left flank pain and vomiting. Computed tomography showed a cluster of small bowel loops encased in a sac located amidst the stomach, the pancreas, and the left kidney, the latter of which was normal without hydronephrosis (Fig. 1). The diagnosis of a left paraduodenal hernia was made using an upper gastrointestinal series with small bowel follow-through, which revealed loops of jejunum clumping over the left upper quadrant of the abdomen (Fig. 2A). These loops were identified in the posterior wall of the stomach (Fig. 2B). With the patient's left flank pain progressively worsening, a laparotomy was performed via a midline incision. Exploration revealed that about one third of the proximal small bowel was encapsulated in a peritoneal sac formed by a peritoneal flap of the left mesentery. The orifice of the hernia sac was located below the inferior mesenteric vein, with engorgement and crowding (Fig. 3). The small bowel was viable and was easily reduced after herniotomy. The defects in the left mesocolon and the hernia orifice were closed. Further inspection of the peritoneal cavity revealed no other abnormality. Postoperatively, the patient had an uneventful recovery and was discharged on postoperative day 5. During the follow-up period of 1 year, he remained completely free of symptoms.

Bottom Line: Paraduodenal hernias are a rare congenital malformation, but they are the most common internal hernias.They develop secondary to a failure in midgut rotation, which may lead to small bowel obstruction or other clinical manifestations.The authors recently experienced a case of a left paraduodenal hernia presenting with unusual symptoms of left flank pain and vomiting.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, College of Medicine, Inha University, Incheon, Korea.

ABSTRACT
Paraduodenal hernias are a rare congenital malformation, but they are the most common internal hernias. They develop secondary to a failure in midgut rotation, which may lead to small bowel obstruction or other clinical manifestations. The authors recently experienced a case of a left paraduodenal hernia presenting with unusual symptoms of left flank pain and vomiting.

Show MeSH
Related in: MedlinePlus