Laparoscopic reduction of paraduodenal hernia in adults. This hernia occurs when the small intestine becomes trapped beneath the colon because of anomalous rotation of the mesentery of the. We report a case of small bowel obstruction due to right paraduodenal hernia in which all the known characteristic findings were demonstrated. Mishra has a clinical approach and incisive style that puts this textbook of laparoscopic hernia repair in a class of its own and makes it a necessary part of every surgeon interested in laparoscopic hernia repair. We present a case that underwent reduction via laparoscopy. In addition to the common inguinal hernias, both direct and indirect. Before 20 years, herniorrhaphy was considered for imaging of hernias. The herniated bowel exerts mass effect on the greater curvature of the stomach, characteristic of a left paraduodenal hernia. Eponymous abdominal hernias, part ii 1 department of radiology, umdnjnew jersey medical school, newark, nj, usa. Paraduodenal hernia, intestinal obstruction, abdominal pain, ct images, laparoscopic surgery background paraduodenal hernias pdh have traditionally been considered the most frequent type of congenital internal hernia 1. Visit and bookmark our covid19 resources page to access the latest guidance, original research, image collection and more.
The second case was also an adult male and was diagnosed as internal hernia by ct. Inguinal, femoral, umbilical, paraumbilical, richter, incisional, spigelian and obturator hernias hernia central. Most abdominal wall hernias should be evaluated by a surgeon when identified. If a loop of bowel passes through the mesenteric defect, that loop is at risk for incarceration, strangulation, or for becoming the lead point of a small bowel obstruction. We report five cases of paraduodenal hernia, all occurring in male patients ranging from 34 to 75 years of age. The number of these cases reported in literature is. The two most common types, the left and right paraduodenal hernia involve small bowel herniating through a congenital opening in the mesenteries. Treitz retroperitoneal hernia, hernia of the fossa of landzert, mesentericoparietal hernia of logace and hernia into the descending mesocolon of callader. The computed tomographic ct findings of a right and left paraduodenal hernia are described. Authored by experienced radiologists and surgeons, imaging in abdominal surgery, by drs.
Above the lower pelvis can be found the littre hernia of meckels diverticulum and the littrerichter hernia of a part of the bowel walls. A hernia is a protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it. Gastroesophageal ge junction and gastric cardia pass through esophageal hiatus paraesophageal rolling hernia. Right small bowel followthrough demonstrates an ovoid cluster of mildly dilated jejunal segments in the left upper quadrant. Review of clinical, imaging and surgical findings in 12 children with surgically proven ih. Paraduodenal hernias paraduodenal hernias occur in paraduodenal fossa. Pericecal hernias dynamic radiology barnard health care. On anatomical and embryological basis, pdh can be broadly divided into right and left pdh.
Written specifically for gastroenterologists at all levels, imaging in gastroenterolog, by drs. Paraduodenal hernias arise from a deficiency in midgut rotation. Ct findings of right paraduodenal hernia presenting as. We report the case of a left paraduodenal hernia as a. 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. If the hernia is large or lung becomes strangulated, surgery may be required lung hernia. Posttherapeutic adhesions of the small intestine were noted following surgical treatment and radiotherapy of two patients with wilms tumors. Poullos, and sidhartha sinha, is an authoritative, singlevolume resource that provides clear, relevant imaging information for th. Both hernias present similarly, but have a differing embryological basis. The outer confines of the hernia sac are well defined. Rsna is committed to connecting radiologists and the radiology community to the most timely and useful covid19 information and resources. This fossa is reported to be present in approximately 2% of autopsy bodies.
Four peritoneal fossae in the ileocecal region as well as congenital and acquired defects in the mesentery of the cecum or appendix may lead to development of a pericecal hernia. Buy meditex uriel hernia belt medium by uriel on free shipping on qualified orders. Paraduodenal hernia, also referred to as internal, congenital, retroperitoneal, or mesocolonic hernia, is a herniation resulting from anomalies of rotation and reduction of the midgut loop in the embryo. Abdominal wall hernias are typically classified by location or etiology. Internal hernias, including paraduodenal traditionally the most common, pericecal, foramen of winslow, and intersigmoid hernias, account for approximately 0. Internal hernias are uncommon in children and their clinical and imaging findings have not been widely addressed. Paraduodenal hernia pdh, a rare congenital anomaly, is a type of internal hernia which occurs due to a defect in the reduction and rotation of the midgut. Left paraduodenal hernia hernia of lanzert is about three times more common than the right coun. Eponymous abdominal hernias, part ii radiology key. Intestinal obstruction secondary to left paraduodenal hernia. Left paraduodenal hernia is an entrapment of the small bowel into the landzert fossa, an unusual congenital peritoneal defect behind the descending mesocolon that results from failure of part of the descending mesocolon to fuse with the posterior parietal peritoneum doishita et al. Internal hernias can also trap adipose tissue fat and nerves. Right paraduodenal herniais due to entrapment of small bowel loops within the.
Herein, the subject of congenital inguinal hernia, including the relevant embryology, related anatomy, the symptoms and signs essential for diagnosis, and the needed examination tests and investigations, is. There are several different types of hernias types, symptoms, diagnosis and treatment. Intestines, hernia intestines, ct 1department of radiology, taejon st marys hospital, the catholic university of korea, 2department of radiology, taejon armed forces general hospital. To determine the spectrum of clinical and imaging findings of internal hernia ih in children and to highlight diagnostic features. For some hernias, notably incisional and hiatal, the outcome appears to be superior using the minimally invasive. Background paraduodenal hernia, or mesocolic hernia, is a rare congenital form of internal abdominal hernia, and is classified into right and left, with left paraduodenal hernia being more common. Angiography may show altered configuration of the jejunal arteries. Ge junction in normal position under diaphragm, fundus in chest. Laparoscopic paraduodenal hernia repair sages abstract. The nature of the repair depends upon the size and location of the.
However, unlike malrotation, the duodenum crosses the midline and the cecum is located in the right lower quadrant. Paraduodenal hernia is a relatively rare cause of acute abdomen, and its diagnosis is often incorrect or. Internal hernias occur when there is protrusion of an internal organ into a retroperitoneal fossa or a foramen congenital or acquired in the abdominal cavity. Laboratory studies are not specific for hernia but may be useful for general medical evaluation. He recognized that inguinal hernias in children were probably congenital in nature and that they could be cured. Paraduodenal hernias are the commonest type of internal hernia, affecting 23% of the population. N2 an internal hernia is the protrusion of a viscus through a normal or abnormal opening within the confines of the abdominal cavity. Federle and james lau, is a unique reference specially tailored to meet the needs of todays general surgeons. One was diagnosed as paraduodenal hernia by ct and diagnosed was revealed by laparoscopy showing a single sac.
The patients had varied manifestations presenting with abdominal pain with or without vomiting and nausea and with or without signs of intestinal obstruction. Importance of subject although internal hernias have an overall incidence of less than 1%, they constitute up to 5. The possibility of diagnosis of paraduodenal hernia. Inguinal hernia in infancy and children intechopen. Because clinical diagnosis of internal hernias is difficult, imaging studies may play an important role if accurate and reliable ct findings can be obtained. Congenital inguinal hernia is a very important subject for both general and pediatric surgeons, and many issues related to the inguinal hernia in infants and children are still confusing. Sigmoidoscopy is no longer recommended as a screening test. Paraduodenal hernia is an uncommon cause of intestinal obstruction. Day in the life of an interventional radiology resident. Paraduodenal hernias, although uncommon, have classically been the most common type of internal hernia. Michael cellini, an interventional radiology resident and see what its like to be on call as a senior resident.
Imaging studies are not required in the normal workup of a hernia 7, 8. There is protrusion of lung outside the thoracic cage black arrows, this is an acquired, posttraumatic lesion caused by the previous insertion of a chest tube. Internal hernias can also be seen secondary to operative interventions. Laparoscopic repair offers equivalent outcomes to open repair, with the additional benefits of greater patient satisfaction and reduced hospitalization. Overview of abdominal wall hernias in adults uptodate.
Internal hernias are protrusions of the viscera through the peritoneum or mesentery but remaining within the abdominal cavity. Approximately 400 years ago, a french surgeon named ambroise pare described the reduction of an incarcerated pediatric hernia and the application of trusses. 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. The mesentery and vessels, as well as the bowel loops, are incorporated into the hernial sac. However, ct evaluation of any type of internal hernia is rare in the radiology literature, except for a few reports on paraduodenal and transmesenteric hernias. They occur when the small bowel herniates into the paraduodenal fossa and can manifest as intestinal obstruction. Paraduodenal hernias, being the most common type of congenital internal hernias, are responsible for. Emergent laparotomy was performed under the impression of left paraduodenal hernia, and an incarcerated jejunum with perforation was found in the left paraduodenal fossa. Internal hernias have a low incidence of radiology. Repair of simple and complex abdominal hernias by the laparoscopic technique is now the method of choice in many centres. However, the incidence of postoperative internal hernias has been increasing recently. The radiologic and arteriographic diagnostic signs of paraduodenal hernias, as based upon their anatomic features, are described and illustrated.371 913 1073 323 398 1033 773 140 1398 637 1255 15 970 1039 992 804 273 1001 1530 1066 1249 287 32 1245 654 83 739 143 1134 1189 953 488 890 1449 774 1022 397 1336 169 275