Figure - uploaded by John D Mellinger
Content may be subject to copyright.
Stage 21 (day 52) of right paraduodenal hernia development where SMA = superior mesenteric artery, Prox Pre-A = proximal segment of prearterial limb and Dis Pre-A = distal segment of prearterial limb of gut, Post-A = postarterial limb of gut, Appy = appendix, and Cecal Div = cecal diverticulum.
Source publication
Right paraduodenal hernia (PDH) results from a primitive gut malrotation. The resultant jejunal mesenteric defect posterior to the superior mesenteric vessels allows decompressed jejunum to herniate retroperitoneally. PDH make up 53% of all internal hernias, but account for only 0.2% to 5.8% of all cases of intestinal obstruction. In addition, PDH...
Similar publications
Effects of pneumoperitoneum on liver function during laparoscopic procedures in most patients have no clinical relevance. However, with increasing number and types of surgical procedures the laparoscopic operation is now performed in high-risk patients, including patients with pre-existing liver disease. In these patients laparoscopic procedures ma...
The key to successful rectal cancer resection is to perform complete total mesorectal excision (TME). Laparoscopic TME can be challenging, especially in the narrow confines of the pelvis. Robotic-assisted surgery can overcome these limitations through superior three-dimensional (3-D) visualization and the increased range of movements provided by th...
To evaluate the effects of increased intraperitoneal pressure caused by carbon dioxide pneumoperitoneum on the hepatic and renal morphology of rats.
Fifty-four adult male rats were randomly divided into three groups (P, PP and C) after anesthesia: P - in 18 animals, pneumoperitoneum was established for 30 minutes immediately before laparotomy; PP -...
Needle aspiration and core biopsies are commonly used to assess retroperitoneal lymph nodes. However, the tissue obtained by this method is insufficient to define and type the tumour. This article demonstrates the feasibility and safety of the laparoscopic approach in obtaining an adequate volume of lymph node tissue for typing.
Laparoscopic retrop...
The present study evaluated the correlation between arterial CO2 and exhaled CO2 during brief high-pressure pneumoperitoneum. Patients were randomly distributed into two groups: P12 group
(n=30) received a maximum intraperitoneal pressure of 12mmHg, and P20 group (n=37) received
a maximum intraperitoneal pressure of 20mmHg. Arterial CO2 was evaluat...
Citations
... It can result in less pain, shorter hospital stays, faster recovery, less scarring, reduced risk of infection, better visualization, and reduced bleeding. Over the past few years, there have been reports indicating that laparoscopic treatment can be a safe and feasible surgical alternative for managing mesocolic hernias in suitable patients [6,7]. Thus, we also preferred to perform the treatment of our patient via a laparoscopic approach. ...
Mesocolic hernias are a rare cause of small bowel obstruction that occurs when a loop of small bowel herniates through a defect in the mesocolon. We present a case of a 35-year-old male with a mesocolic hernia causing small bowel obstruction, who was successfully treated with laparoscopic reduction and repair. The patient had an uneventful recovery and was discharged on postoperative day 3. Mesocolic hernias should be considered in the differential diagnosis of small bowel obstruction, and prompt diagnosis and surgical intervention are essential to prevent complications such as bowel ischemia and perforation. Laparoscopic treatment can be a safe and effective option for the management of mesocolic hernias. This case report highlights the clinical presentation, radiological features, and surgical management of mesocolic hernias, with a focus on the role of laparoscopy in the treatment of this rare condition.
... Laparoscopy exploration is recommended after a multidisciplinary consultation after various medical examinations fail to identify the cause of ascites and abdominal pain. Laparoscopy exploration [2] revealed an intra-abdominal hernia (Fig. 1e) after the 4 th day of hospitalization. Subsequently, during the operation, it was found that the omentum and the ileocecal adhered, the fibrous cord formed a hernia ring, the ileum at the end of approximately 15 cm herniated into it, and a part of the small intestine was necrotic, the necrotic bowel was removed by laparotomy (Fig. 1f). ...
1c and d). It continued to produce massive ascites all the time for the past 3 days. Another complete blood count showed a continuous drop in hemoglobin. Laparoscopy exploration is recommended after a multidisciplinary consultation after various medical examinations fail to identify the cause of as-cites and abdominal pain. Laparoscopy exploration [2] revealed an intra-abdominal hernia (Fig. 1e) after the 4 th day of hospitalization. Subsequently, during the operation, it was found that the omentum and the ileocecal adhered, the fibrous cord formed a hernia ring, the ileum at the end of approximately 15 cm herniated into it, and a part of the small intestine was necrotic, the necrotic bowel was removed by laparoto-my (Fig. 1f). The man was cured and free from the hospital, and telephone follow-up showed that the patient recovered without sequelae. As we know, the vast majority of hernias can be diagnosed by symptoms, signs, ultrasound, and CT. [3] However, there are still some types of hernias to be diagnosed by exploration, and laparoscopic exploration can be one of the options. To confirm the diagnosis in time for the unusual intra-abdominal hernia and reduce the delay of diagnosis, we can learn the following points from the case: 1. Intra-abdominal hernia becomes one of the causes of as-cites (bloody ascites); [4] 2. Under the current circumstances, when the diagnosis is unclear, the abdomen should be explored as soon as possible (laparoscopy) to reduce the duration of pain of the patient and the length of intestinal necrosis; To the Editor, Clinicians will see many types of hernias. Intra-abdominal hernia is a type of hernia. The occurrence of intra-abdominal hernia is almost related to the bowel. The most common type is inguinal hernia. [1] As we all know, intestinal hernia is a type of intra-abdominal hernia. This paper presents a case of an unusual intra-abdominal hernia with bloody ascites as the main clinical manifestation using laparoscopy exploration. A 66-year-old man presented with abdominal pain and vomiting for 4 h. The physical examination did not reveal a cause of abdominal pain. No obvious abnormality was revealed by complete blood count or computed tomography of the abdomen. Serum amylase (AMY) is 156 U/L (the upper limit of the reference interval of AMY is 110 u/L). Apart from abdominal pain and vomiting, the man denied any other abnormal symptoms , history of other chronic medical conditions, surgery, or trauma. Physical examination also showed no obvious abnormality. The man left the hospital after abdominal pain was improved by intravenous infusion of anti-inflammatory drugs, gastric mucosal protectants, and antispasmodics. However, 10 h later, the patient came to our hospital for another visit with abdominal pain after leaving the first visit to a doctor. To get a clarity of the diagnosis, the man was in the hospital for a thorough examination. Ultrasonography and repeat CT of the abdomen revealed the presence of as-cites (Fig. 1a and b). The repeat serum AMY was 64 U/L. By draining the ascites and measuring the volume of ascites (Fig. Cite this article as: Wang SP, Zhang GM. Intestinal hernia: An unusual intra-abdominal hernia with bloody ascites as the main clinical manifestation.
... Laparoscopy exploration is recommended after a multidisciplinary consultation after various medical examinations fail to identify the cause of ascites and abdominal pain. Laparoscopy exploration [2] revealed an intra-abdominal hernia (Fig. 1e) after the 4 th day of hospitalization. Subsequently, during the operation, it was found that the omentum and the ileocecal adhered, the fibrous cord formed a hernia ring, the ileum at the end of approximately 15 cm herniated into it, and a part of the small intestine was necrotic, the necrotic bowel was removed by laparotomy (Fig. 1f). ...
... Since Uematsu et al 4 reported the first laparoscopic repair of paraduodenal hernia in 1998, many reports have described laparoscopy as a diagnosis or repair tool for paraduodenal hernia (Table 1). 14,20,[28][29][30][31][32][33][34][35][36][37][38][39][40] Laparoscopic surgery has been implemented in many surgical fields. Several reports have demonstrated feasibility and benefits in terms of cosmetic aspects and reduced pain, rendering SILS an alternative method to conventional and multiport laparoscopic surgery. ...
Paraduodenal hernia is traditionally repaired via conventional laparotomy. Recently, several reports described the repair of paraduodenal hernia via laparoscopic surgery with multiple ports. Due to development of the technique and devices for laparoscopic surgery, single-incision laparoscopic surgery (SILS) has been applied to various operations, including cholecystectomy, appendectomy, and procedures for colorectal cancer. Here, we report treatment of a left paraduodenal hernia via SILS. A 23-year-old man presented with abrupt onset of abdominal pain, nausea, and vomiting. Computed tomography revealed a mass of intestinal loops enveloped by a thin capsule on the left of the abdominal cavity. Blood circulation in the jejunal loops was preserved, and no dilatation of the jejunum was observed. Physical and radiographic examination indicated the possibility of left paraduodenal hernia; we performed paraduodenal hernia repair using SILS. After we confirmed that there was no strangulation or gangrenous change in the bowel on laparoscopic examination, we reduced the incarcerated jejunum loops via an atraumatic method. The postoperative course was uneventful, and the patient was discharged 8 days after the operation. This disease affects relatively young patients, rendering this operation attractive from the viewpoint of cosmetic benefits and minimal invasion. Paraduodenal hernia repair via SILS is feasible, safe, and may constitute an alternative method for paraduodenal hernia without necrotic change.
... While left-sided paraduodenal hernias occur with equal frequency in men and women, right-sided paraduodenal hernias arise three times more frequently in men [1]. Internal hernias are reported to cause 0.2-5.8% of all cases of small bowel obstruction [2]. Paraduodenal hernias occur due to an error in the reduction and rotation of the midgut during embryonic development [3,4]. ...
With an incidence of less than 1%, paraduodenal hernias are very rare but account for ~0.2-5.8% of mechanical small bowel obstruction and carry a mortality rate of 20-50%. Right-sided paraduodenal hernias are three times less frequent than left-sided paraduodenal hernias. We report the case of a 37-year-old man who suffered from colicky abdominal pain accompanied by vomiting. The computed tomography scan showed a mechanical ileus, caused by a presumed paraduodenal hernia, and we chose an elective laparoscopic surgical approach. The patient recovered quickly and was discharged on the second postoperative day. Paraduodenal hernias are a diagnostic challenge as they are typically characterized by long-term non-specific abdominal symptoms and are only detected in the event of acute intestinal obstruction. Until now, laparoscopic therapy has only been described in eight case reports and we review this rare condition and the surgical options.
... As a result, the small bowel becomes trapped in a hernial sac formed by the peritoneum behind the colonic mesentery, where the cecum and ascending colon rotate anteriorly. 6,14 The most frequently encountered fossae are: inferior of Treitz (60%), combinated superior and inferior (30%), superior (5%), fossa of Landzert (2%) and fossa of Waldeyer (1%). 4,6 The left paraduodenal fossa lateral to the fourth portion of the duodenum and posterior to the inferior mesenteric vein (IMV) and left colic artery is present (fossa of Landzert). ...
... 6,14 The most frequently encountered fossae are: inferior of Treitz (60%), combinated superior and inferior (30%), superior (5%), fossa of Landzert (2%) and fossa of Waldeyer (1%). 4,6 The left paraduodenal fossa lateral to the fourth portion of the duodenum and posterior to the inferior mesenteric vein (IMV) and left colic artery is present (fossa of Landzert). In the case of right PDH (lateral and posterior to the third portion of the duodenum in Waldeyer's fossa) which is closely related to the superior mesenteric axis. ...
An internal hernia is a protrusion of bowel through a normal or abnormal orifice in the peritoneum or mesentery and the resulting hernia remains intraperitoneal. The para-duodenal type is the most common type of congenital internal hernias. We reported a case of left paraduodenal hernia, who presented with recurrent attacks of severe abdominal pain and occasional vomiting. The case was diagnosed as a left huge paraduodenal hernia, and prepared for a laparoscopic repair after which he made uneventful recovery and remained free of symptoms when he was seen for follow up in surgery outpatient clinic.
... The fossa of Waldeyer extends inferior to the third and fourth part opening being just inferior to the duodenojejunal junction and bound anteriorly by the inferior mesenteric vein and the ascending left colic artery (Figs 4 and 5). 7 Handling patients presenting with a history of recurrent pain in the abdomen and ill-defined complaints often leads to misdiagnosis; a history of partial or complete intestinal obstruction might also be present. However, small bowel contrast radiography/ CECT abdomen is the lynchpin of a preoperative diagnosis. ...
... Surgical repair of PDH has shifted dramatically from open laparotomy to laparoscopic procedures [5]. The clinical features of right-sided PDH have been described [4,[6][7][8], and advances in laparoscopic surgical techniques have permitted the safe and effective laparoscopic treatment of right-sided PDH [4,[6][7][8][9][10][11][12][13]. This report describes the successful laparoscopic repair of a right-sided PDH in an adult patient. ...
... PDHs are congenital mesocolic hernias caused by an abnormal rotation of the primitive midgut in embryonic life [11]. ...
... Thus, the employment of abdominal CT is very helpful for the correct diagnosis. In fact, accurate preoperative diagnosis of PDH can be made by multidetector CT, which can detect the encapsulation of small bowel loops in the right midabdomen with looping of arterial and venous jejunal branches behind the superior mesenteric artery in right PDH and the encapsulation of bowel loops at or above the level of the ligament of Treitz with intermittent dilatation in left PDH [38].Contrast-enhanced CT may also be required for an accurate diagnosis of PDH [11]. PDH can be repaired by reduction of hernia contents and excision of the hernia sac, with or without intestinal 3 Case Reports in Surgery derotation, thereby avoiding injury to the major mesenteric vessels juxtaposed to the hernial orifice. ...
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.
... Instead of the usual 270 degrees anticlockwise rotation, the prearterial segment arrests at 9 O'clock position with 90 degree anticlockwise rotation alone. 3 The postarterial limb, however, continues in its normal rotation pattern and thus the cecum and ascending colon fuses to the parietes above the abnormal prearterial segment, thereby entrapping it in an internal hernia in the so-called fossa of Waldeyer. There are eight reports of laparoscopic repair of right paraduodenal hernia in literature prior to ours. ...
Laparoscopic repair of a right paraduodenal hernia has been described sparingly in literature. We present an account of how we laparoscopically repaired a right paraduodenal hernia along with a review of the current literature as regards the various techniques that have been attempted. With the patient in supine position, and with umbilical camera port and three 5 mm ports, we mobilized the cecum and ascending colon up to the third part of the duodenum, thereby widening the neck of the hernia sac in the Waldeyer fossa. This method is ideal for the less severe incomplete rotation presenting with right paraduodenal hernia where there are no Ladd's bands and there is no requirement for fetalization of the bowel.
... 5 Some reported cases advocate repairing the defect between the mesentery of the ascending colon and the parietal peritoneum with non-absorbable sutures. 5 In contrast, the hernia sac can be widened and the bowel contents reduced, as performed in this case. 1 While laparoscopic repair has been described, surgical approach is largely decided based on the clinical scenario and surgeon experience. 3 6 Bowel resection may be required if irreversible ischaemia or necrosis is present, which could have further complicated this scenario given the proximity to the pancreaticoduodenal structures. ...
We report an unusual case of a strangulated internal hernia resulting from a right paraduodenal fossa hernia (PDH) in the context of bowel malrotation. There are few documented cases of PDHs associated with a concomitant gut malrotation. Emergency laparotomy was performed based on clinical and radiological. Intraoperatively, the proximal jejunum was seen to enter a hernia sac formed by an aberrant duodenojejunal flexure located to the right of the aorta. This was presumed to be a strangulated internal hernia of the paraduodenal recess in a malrotated gut. The hernia neck was widened and the sac obliterated to allow reduction of the contents. On reduction and warming, the insulted small bowel appeared viable and returned to the abdominal cavity without resection.
