• Bowel obstruction
• Computed tomography
• Internal hernia
• Mesenteric whirling
• Paraduodenal hernia

• 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

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

Paraduodenal hernia is a rare internal hernia which accounts for only 1% of all intestinal hernias. There have been limited reported cases of paraduodenal hernia treated by laparoscopic surgery. We report a case of left paraduodenal hernia that was successfully treated by single-incision laparoscopic surgery (SILS).

A 17-year-old woman presented with left upper abdominal pain. An abdominal enhanced multi-detector computed tomography demonstrated encapsulated cluster of small bowel loops in the left upper quadrant which passed through the dorsal side of the inferior mesenteric vein, and showed that blood flow of the prolapsed small bowel was preserved. We preoperatively diagnosed left paraduodenal hernia without ischemia or necrosis. We performed elective SILS because she was a young actress training school student and cosmetic benefit was thought to be important. We pulled out the protruded small bowel and closed a defect with a running suture by SILS. The patient was discharged 3 days after the surgery with no complications.

We reported the case of left paraduodenal hernia successfully diagnosed and treated by SILS.

• Internal hernia
• Left paraduodenal hernia
• Single-incision laparoscopic surgery (SILS)

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

An internal hernia is the protrusion of visceral contents through a congenital or acquired defect in the peritoneum or mesentery within the abdominal cavity. In approximately 0.6–5.8% of patients with small intestinal obstruction, the cause is internal hernia, with paraduodenal hernias accounting for approximately 40% of cases. Here, we present the case of a 51-year-old man diagnosed with obstruction of the small intestine caused by a hernia on the left side of the duodenum. The treatment involved returning the bowel loops to the normal position and closing the hernia pocket using Prolene 2.0 sutures. The duration of the surgery was 30 min. Five days later, the patient’s condition was stable and he was discharged from the hospital; at the 32-month postoperative follow-up, he remained in stable condition with no recurrence. An abdominal computed tomography scan is valuable for early diagnosis of paraduodenal hernia in the absence of complications, and the cause can be identified and the bowel returned to the normal position by endoscopic surgery, with closure of the hernia pocket if the intestine does not stick to the pocket.

• internal hernia
• intestinal obstruction
• open surgery
• paraduodenal hernia

Paraduodenal hernias (PDHs) are rare entities that may present with acute or subacute symptoms, and which pose challenges to prompt diagnosis and treatment. The minimally invasive management of these hernias is emerging as a new compelling approach to optimize surgical recovery. We present the case of a 42-year-old female patient who presented with acute abdominal pain and symptoms of bowel obstruction. Abdominal imaging suggested the presence of a left PDH. Laparoscopic exploration was performed. Intestinal malrotation was noted with incarceration of a small bowel loop in the Landzert fossa. The incarcerated bowel loop was freed and primary repair of the hernial defect was performed. PDHs are usually congenital and involve a herniation of abdominal content into the left mesocolon, between the mesocolon and the posterior abdominal wall. Minimally invasive treatment, consisting of adhesiolysis and repair of the hernial defect, seems to be a valid and safe option.

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Paraduodenal hernias are the commonest type of internal hernia.

Paraduodenal hernias are the most common type of internal hernia but a rare cause of bowel obstruction. Given the high risk of incarceration, obstruction and associated mortality, surgical repair is recommended.

We present a novel technique for laparoscopic repair of paraduodenal hernia using biosynthetic mesh to reinforce suture closure of the hernia defect. An 18-year-old healthy female presented with symptoms of recurrent subacute small bowel obstruction and right paraduodenal hernia was diagnosed on computed tomography (CT). Laparoscopic repair was performed with reinforcement of suture repair with GORE® BIO-A® Hiatal Tissue Reinforcement to decrease the risk of recurrence. The patient had an uneventful recovery and was discharged on the second post-operative day. Subsequent follow-up revealed complete resolution of symptoms.

Biosynthetic tissue reinforcement carries a lower theoretical risk of erosion than permanent mesh. A hiatal-shaped prosthesis represents a suitable shape for paraduodenal hernia repair.

We present the first reported use of bioabsorbable mesh to repair paraduodenal hernia. This technique may minimise risk of mesh erosion and can be considered a safe and effective approach where suture repair is inadequate due to large defect size.

• Bioabsorbable mesh
• Case report
• Internal hernia
• Paraduodenal hernia
• Paraduodenal hernia repair

• gastrointestinal surgery
• general surgery

• gastrointestinal surgery
• general surgery

• Hernia
• Internal
• Mesocolic
• Obstruction
• Paraduodenal

A 56-year-old Japanese female presented with vomiting, nausea, and abdominal pain after excessive drinking and eating. Abdominal computed tomography showed an encapsulated circumscribed cluster of jejunal loops in the right upper quadrant. She was diagnosed with a strangulated intestinal obstruction caused by right paraduodenal hernia (PDH) and underwent an emergency laparoscopic repair. A view through the endoscope showed the right PDH, which was encapsulated under the mesocolon. Most of the small bowel was entrapped and adhered inside the sac, requiring careful adhesiolysis. The hernia orifice was expanded to a sufficient degree, and the strangulation was relieved, avoiding the need of resecting the small intestine. Recovery was uneventful, and the patient remains free of symptoms 3 years after surgery. Findings in a total of 29 patients (including this report) who underwent laparoscopic repair of right or left PDHs in Japan are discussed.

•

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

• Laparoscopy
• hernia
• paraduodenal

• Intestinal obstruction
• laparoscopy
• left 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

Paraduodenal hernia is a rare congenital anomaly that arises from an error of rotation of the midgut. The duodenum and the small intestine become trapped in a sac which is lined by the peritoneum, behind the mesentery of the colon, either to the right or left of the midline. It is therfore a rare and potentially life-threatening condition that can cause intestinal obstruction progressing to strangulation and perforation. We report a case of a 55-year-old patient presenting a left paraduodenal hernia diagnosed intraoperatively after being operated on in the emergency setting for acute abdomen. The small bowel was twisted upon its mesentery and was entrapped in a large left paraduodenal space. Fortunately, once the bowel was reduced from the paraduodenal space, the blood flow was reestablished and the small bowel resumed a proper functioning. The mouth of the sac was obliterated by suture opposition to the posterior wall. The patient's subsequent hospital course was uneventful, and he was discharged in satisfactory condition 4 days postoperatively.

• Paraduodenal hernia
• acute abdomen
• left

Paraduodenal hernia is an uncommon cause of acute abdominal pain; however, it is the commonest of internal herniation. Computer tomography of the abdomen is diagnostic. Although it is a rare cause of intestinal obstruction, it is estimated that more than half of paraduodenal hernias develop symptoms. We present a case of left paraduodenal hernia that presented with acute abdominal pain and a left upper abdominal mass. Symptoms resolved spontaneously and a planned Laparoscopic repair was performed. The malpositioned small intestine was reduced from the hernia sac and the hernial orifice was closed. The patient made a rapid recovery with no recurrence of symptoms at 3-year follow-up.

• Paraduodenal hernia
• internal hernia
• intestinal obstruction

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

• Abdomen, Acute/surgery
• Anesthesia/methods
• Digestive System Diseases/surgery
• Emergency Treatment/methods
• Female
• Genital Diseases, Female/surgery
• Hemodynamics/physiology
• Humans
• Ischemia/surgery
• Laparoscopy/methods
• Mesenteric Ischemia
• Monitoring, Physiologic
• Obesity/complications
• Patient Selection
• Positive-Pressure Respiration
• Posture
• Pregnancy
• Pregnancy Complications/surgery
• Randomized Controlled Trials as Topic
• Respiratory Physiological Phenomena
• Vascular Diseases/surgery

Internal hernias of the abdomen are uncommon. They represent less than 1% of bowel obstruction cases. The left Paraduodenal hernia (PH) is the most frequent type of internal hernias. We report a case of 77 year- old woman consulting for bowel obstruction evolving since two days. The abdominal computed tomography revealed a retroperitoneal small bowel contained in a peritoneal sac. The surgical exploration confirmed the diagnosis of a left internal PH by showing incarcerated jejunal loops in a PH through a narrow opening to the left of the angle of Treitz. A surgical reduction of the hernia and closure of the hernia neck were performed. The follow-ups were uncomplicated. Through this observation and a literature review, we try to recall the clinical and radiological characteristics of this disease and to clarify the therapeutic modalities.

• Computed tomography
• internal hernia
• paraduodenal hernia
• small bowel obstruction

Para duodenal hernia is among the uncommon and rare causes of intestinal obstruction, but it is the most common type of internal hernia in abdomen and accounts for more than half of cases that do occur. Here, we are reporting a case of right Para duodenal hernia, reduced and repaired laparoscopically. This thirteen year old girl presented to us with features of small bowel obstruction of two days duration. Plain abdominal X-ray showed multiple fluid levels confined to right side of abdomen. A diagnostic laparoscopy was done under General Anaesthesia. Right Para duodenal hernia was found with small bowel confined to the right side between the ascending colon and hepatic flexure of colon. Laparoscopic reduction of contents of the hernia was done starting from the Ileocaecal junction. Hernial opening was closed laparoscopically with nonabsorbable suture. Patient is quite well till date and has had no recurrence of symptoms

• Laparoscopy
• para duodenal hernia
• small bowel obstruction

• paraduodenal hernia
• small bowel obstruction
• left flank pain

• Adult
• Hernia/complications
• Hernia/diagnosis
• Hernia/pathology
• Herniorrhaphy
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Male

• Abdomen, Acute/etiology
• Aged
• Aged, 80 and over
• Female
• Hernia/classification
• Hernia/complications
• Hernia/pathology
• Humans
• Intestinal Diseases/classification
• Intestinal Diseases/complications
• Intestinal Diseases/pathology
• Intestinal Obstruction/etiology
• Male
• Middle Aged
• Peritonitis/etiology
• Retrospective Studies

Internal herniation of the small bowel is a relatively rare cause of intestinal obstruction. Left paraduodenal hernia resulting from abnormal rotation of the midgut during embryonic development is the most common form of congenital internal hernia. We report our experience in the diagnosis and management of a young male with left paraduodenal hernia presenting as recurrent intestinal obstruction. Correct preoperative diagnosis of left paraduodenal hernia had been difficult due to non-specific clinical presentations, but the advent of modern imaging technology makes early and correct diagnosis possible. Due to the risk of obstruction and strangulation, surgical treatment is indicated; however, timely intervention increases the likelihood of a favorable outcome.

• Internal hernia
• Paraduodenal hernia
• Small bowel obstruction

• Adult
• Diagnosis, Differential
• Duodenal Diseases/complications
• Duodenal Diseases/pathology
• Duodenum/pathology
• Hernia/complications
• Hernia/pathology
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/pathology
• Male

• Abdominal Wall/anatomy & histology
• Cadaver
• Duodenum/anatomy & histology
• Duodenum/surgery
• Hernia, Abdominal/etiology
• Humans
• Peritoneum