• Acute abdominal pain
• Bowel ischemia
• Internal hernia
• Left Para duodenal hernia
• Ligament of Treitz

• Paraduodenal hernia
• Waldeyer’s fossa
• fossa of Landzert
• mesocolic hernia
• minimally invasive surgery
• treitz hernia

• Humans
• Female
• Adolescent
• Herniorrhaphy/methods
• Laparoscopy/methods
• Duodenal Diseases/surgery
• Minimally Invasive Surgical Procedures/methods

• Emergency laparotomy
• Emergency, Multidetector computed tomography
• Internal hernia
• Left paraduodenal hernia
• Small bowel obstruction

Paraduodenal hernia (PDH) is a mesenteric-parietal hernia with retroperitoneal and retrocolic herniation of the small bowel into a sac, which is formed by a peritoneal fold located near the fourth portion of the duodenum. The present case revealed that PDH was a possible reason for hydronephrosis, and that the carful laparoscopic exploration surgery was necessary to find infrequent causes of hydronephrosis to avoid invalid Anderson–Hynes pyeloplasty surgery and its injury.

An 8-year-old boy presented to the pediatric department with a chief complaint of cryptorchidism. Afterwards, laparoscopy confirmed hydronephrosis secondary to left PDH with cryptorchid. Then, he received laparoscopic surgery, fixed operation for left PDH, release of the ureteropelvic junction obstruction, and treatment for hydronephrosis. It is necessary to perform secondary surgery for cryptorchidism and long-term follow-up.

The case revealed an extremely rare cause of hydronephrosis in children, suggesting a potential correlation between PDH and hydronephrosis.

• Paraduodenal hernia
• Hydronephrosis
• Cryptorchidism
• Laparoscopic surgery
• Case report

Internal hernias are quite rare, accounting for fewer than 1% of all abdominal hernias. Moreover, the most frequent cause of internal herniation is paraduodenal hernia (PDH). Diagnosing paraduodenal hernias can be difficult due to the wide range of symptoms that can occur. It is a case report of paraduodenal hernia that was diagnosed and managed in a tertiary center. We describe the case of a 55-year-old male patient who had been experiencing nonspecific abdominal discomfort for the last 5 years and had several comorbidities and positive serology. An abdominal computed tomography (CT) revealed that he had a left PDH, which was effectively treated with laparoscopic surgical repair. The study's strength is that it was correctly identified by CT and subsequently laparoscopically corrected. A gastrografin swallow study was also performed postoperatively to ensure there was no leak. The study's flaw is that the patient was misdiagnosed for five years in other medical facilities. Because paraduodenal hernia is an uncommon diagnosis, it's important to keep it in mind as one of the differential diagnoses for persistent discomfort. It also needs accurate imaging in order to identify and successfully manage it. To demonstrate the relevance of this uncommon condition, future research is needed to report on any misdiagnosis or treatment. To conclude, nowadays the best option for paraduodenal hernia repair is laparoscopic surgery. However, because it can present with a wide variety of symptoms and diagnosis might be challenging, it demands a high index of suspicion. The gold standard for identifying paraduodenal hernia is still a CT scan of the abdomen. Patients who are stable and have no signs of intestinal obstruction might decide to have their hernia repaired to avoid future problems. To demonstrate the relevance of this uncommon condition, future research is needed to report on any misdiagnosis or treatment.

• Paraduodenal hernia (PDH)
• case report
• laparoscopy

Internal hernias represent the penetration of intestinal loops through congenital or acquired openings within the mesentery or peritoneum. One such hernia is the paraduodenal hernia, which is the most common type of internal hernia (53%) (Yun et al., 2010) [1]. Due to the variable and non-specific clinical presentation, it is difficult to make a correct diagnosis. Preoperative computed tomography of the abdomen facilitates diagnosis and timely surgical intervention, which can be performed openly or laparoscopically (Coakley et al., 2012) [2].

In this paper, the case of a 39-year-old patient with left paraduodenal hernia will be presented. He arrived in the emergency department with sudden onset of abdominal pain. The diagnosis was established using computed tomography and an open surgical procedure was successfully performed.

Clinical presentation of paraduodenal hernia ranges from asymptomatic to manifest. The greatest difficulty regarding management of paraduodenal hernias lies in their diagnosis. Many studies have shown that the best option for diagnosis is computed tomography (CT). Open and laparoscopic techniques are used in treatment of paraduodenal hernias with similar results.

The case of a 39-year-old male patient with LPDH with non-specific symptomatology was presented. CT scan is the best diagnostic option for this condition. Open surgical approach was used with great success.

•

Internal hernias represent the penetration of intestinal loops within the mesentery.

• Case report
• Internal hernia
• Paraduodenal hernia

A left paraduodenal hernia is a rare type of internal hernia but the most common type of peritoneal recess hernia. Preoperative diagnosis of a left paraduodenal hernia is difficult because of its nonspecific clinical manifestations, and it is often confused with other causes of acute abdomen. Diagnosis is therefore often delayed, resulting in serious clinical outcomes. We herein report a case of a large paraduodenal hernia with small intestinal obstruction and ischemia without abdominal pain. The patient was successfully discharged after emergency hernia repair. This case reveals the importance of diagnosing a left paraduodenal hernia with or without abdominal pain, especially in patients with no history of abdominal surgery.

• Left paraduodenal hernia
• acute abdomen
• internal hernia
• intestinal obstruction
• peritoneal recess hernia
• preoperative diagnosis

Paraduodenal hernias are of congenital origin and may present with symptoms and signs of small intestinal obstruction. These hernias are rare in our practice, and a definitive preoperative diagnosis is often not made as the symptoms are not specific. Early assessment and prompt and adequate resuscitation and surgery obviate the risk of strangulation and intestinal resection. This report highlights a rare cause of intestinal obstruction in a young male who presents with all the classical features of obstruction: colicky abdominal pain, distension, vomiting, and inability to pass stool or flatus. The diagnosis of paraduodenal hernia was made intraoperatively. We do not routinely request for barium examination or abdominal computed tomography scan in acute abdominal pain. These modalities can suggest a preoperative diagnosis.

• Congenital origin
• intestinal obstruction
• paraduodenal hernia

• Hernia
• Internal
• Mesocolic
• Obstruction
• Paraduodenal

• Obstructed paraduodenal hernia
• Paraduodenal hernia

•

Congenital internal hernias are an infrequent condition resulting from the protrusion of abdominal organ through an intra-peritoneal defect.

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.

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.

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.

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.

• Internal hernia
• Intestinal obstruction
• Landzert fossa
• Left paraduodenal hernia

•

Paraduodenal hernia is a rare disease but the most common internal hernia.

Paraduodenal hernia is a rare disease but the most common internal hernia. Laparoscopic repair of paraduodenal hernia is feasible and effective because of its minimal invasiveness and aesthetic advantage.

We report a case of a 79 year-old-man who was admitted with a complaint of recurrent left abdominal pain. Computed tomography revealed an encapsulated cluster of jejunum loops in the left upper quadrant, near the ligament of Treitz and at the dorsal side of the inferior mesenteric vein. Emergency laparoscopic surgery was performed. The jejunum loops incarcerated in the hernia sac was reduced. The hernia orifice was closed with interrupted suture. Postoperative period was uneventful and the patient was discharged home on the 7^th postoperative day. There has been no recurrence during a follow-up.

If there is a working space in the abdominal cavity, laparoscopic surgery for paraduodenal hernia leads to patient’s early recovery with cosmetic satisfaction.

Left paraduodenal hernia is a rare cause of small bowel obstruction that should be thought about patient with a history of recurrent abdominal pain. Computed tomography is the standard for a correct diagnosis. Laparoscopic repair as the first surgical option for paraduodenal hernia is feasible despite of technical difficulties.

• Laparoscopic surgery
• Paraduodenal hernia
• Small bowel obstruction

• Abdominal pain
• CT images
• Intestinal obstruction
• Laparoscopic surgery
• Paraduodenal hernia

• Abdominal Pain/etiology
• Adult
• Aged
• Duodenal Diseases/diagnosis
• Duodenal Diseases/surgery
• Duodenum/surgery
• Hernia/complications
• Hernia/diagnostic imaging
• Herniorrhaphy/methods
• Humans
• Intestinal Obstruction/surgery
• Laparoscopy/methods
• Male
• Vomiting/etiology

Paraduodenal hernias are rare congenital internal hernias accounting for <2% of intestinal obstruction. Left paraduodenal hernias (LPDHs) into the fossa of Landzert are the more common type and result from abnormal rotation of the midgut and failure of peritoneal fusion. Sequelae of these hernias usually occur spontaneously in the 4th or 5th decade of life and are more common in males and have a significant risk of incarceration and subsequent strangulation. We describe a case of a 15-year-old female who develops a LPDH following laparoscopic appendectomy, resulting in jejunal incarceration and subsequent small intestinal obstruction. The patient discussed is from an atypical demographic, being young and female. In addition, the precipitating event prompting incarceration of the hernia appears to be the application of pneumoperitoneum, placement in the Trendelenburg position, and manipulation of small intestine for the purpose of facilitating laparoscopic appendectomy. To our knowledge, this is the first reported case of LPDH exacerbated by laparoscopic procedure.

• internal hernia
• paraduodenal hernia

•

Left paraduodenal hernia is a potentially severe cause of small bowel obstruction.

Internal hernia is a pathological condition resulting from abnormal protrusion of abdominal viscera through an opening in the intraperitoneal recesses of the abdominal cavity. Small bowel obstruction due to internal hernia is not common (0.25–0.9% of cases). The most common group is that of paraduodenal hernias (53%), of which the left-sided one is the most common type (75%).

We report a case of a 43 year-old man with a history of recurrent abdominal pain, who was hospitalized because of an episode of acute small bowel obstruction. He had no previous surgery. Computed tomography revealed an encapsulated circumscribed cluster of jejunal loops in the left upper quadrant, near the ligament of Treitz, and the hernia orifice was adjacent to the left side of the inferior mesenteric vessels. Emergency laparoscopic surgery was performed: the small bowel was found completely herniated under the inferior mesenteric vessels. It was gradually reduced and the hernia space was closed with a running suture. The patient was discharged on the fourth day without complications.

Left paraduodenal hernia is a rare cause of small bowel obstruction that should be taken into account in a patient with a history of recurrent abdominal pain or intestinal obstruction, and no previous surgery. Computed tomography is the standard for a correct diagnosis. Surgery is treatment of choice, because it reduces the risk of emergency and complications associated to hernia. Laparoscopic approach is feasible and effective, also in emergency situation.

• Laparoscopic treatment
• Left paraduodenal hernia
• Small bowel obstruction

•

A paraduodenal hernia is an uncommon hernia that results from an abnormal rotation of the midgut.

A paraduodenal hernia is an uncommon hernia that results from an abnormal rotation of the midgut. Commonly, these hernias are congenital in nature, and are reported to cause 1.5–5.8% of intestinal obstructions. These hernias occur when a part of the jejunum herniates through the posterior portion of the ligament of Treitz. Diagnosing these hernias preoperatively has been shown to be difficult, despite the studies that are available. Early diagnosis is imperative to the patient in order to avoid strangulation of the bowel, which is associated with a high mortality.

In this case, we present a case of a left-sided paraduodenal hernia in a virgin abdomen in a 38-year-old African American male with a herniation of a loop of jejunum through a defect of the posterior portion of the ligament of Treitz. The patient also had a volvulized segment of the proximal jejunum, and part of this bowel was found to be ischemic.

Acute intestinal obstruction caused by a left paraduodenal hernia is a rare cause of intestinal obstruction. A literary search of PubMed between 1980 and 2012 indicated only 44 cases of intestinal obstruction secondary to a left paraduodenal hernia.

The patient underwent exploratory laparotomy, and the herniated bowel was found to be ischemic. The hernia was reduced, and the ischemic bowel resected. The defect was closed, and the patient had a non-complicated recovery.

• Ligament of Treitz
• Paraduodenal hernia

• Aged
• Duodenal Diseases/surgery
• Hernia
• Herniorrhaphy/methods
• Humans
• Laparoscopy
• Male

• Left paraduodenal hernia
• Small bowel obstruction

• Duodenal Diseases/diagnosis
• Duodenal Diseases/surgery
• Female
• Gastrectomy/methods
• Gastric Bypass/methods
• Hernia/diagnosis
• Herniorrhaphy/methods
• Humans
• Incidental Findings
• Middle Aged
• Obesity, Morbid/surgery

An internal hernia is a protrusion of bowel through a normal or abnormal orifice in the peritoneum or mesentery. Although they are considered as a rare cause of intestinal obstruction, paraduodenal hernias are the most common type of congenital hernias.

A literature search using PubMed was performed to identify all published cases of left paraduodenal hernia (LPDH).

In Literature search between 1980 and 2012 using PubMed revealed only 44 case reports before the present one. Median age was 47 years (range 18 – 82 years). Nearly 50% reported previous mild symptoms. Two-third of patients required emergency surgery in form of laparotomy or laparoscopic repair. Reduction of hernia contents with widening or suture repair of the hernia orifice were the most common standards in surgical management of LPDH.

Intestinal obstruction secondary to internal hernias is a rare presentation. High index of suspicion and preoperative imaging are essential to make an early diagnosis in order to improve outcome.

• Donor nephrectomy
• internal hernia
• laparoscopy