Paraduodenal hernias paraduodenal hernias occur in paraduodenal fossa. Internal hernias are protrusions of the viscera through the peritoneum or mesentery but remaining within the abdominal cavity. Because clinical diagnosis of internal hernias is difficult, imaging studies may play an important role if accurate and reliable ct findings can be obtained. This hernia occurs when the small intestine becomes trapped beneath the colon because of anomalous rotation of the mesentery of the. 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. 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. Laparoscopic reduction of paraduodenal hernia in adults. Internal hernias have a low incidence of radiology. Paraduodenal hernias, although uncommon, have classically been the most common type of internal hernia. Eponymous abdominal hernias, part ii radiology key. Internal hernias can also trap adipose tissue fat and nerves. The mesentery and vessels, as well as the bowel loops, are incorporated into the hernial sac. Paraduodenal hernia is an uncommon cause of intestinal obstruction.
Michael cellini, an interventional radiology resident and see what its like to be on call as a senior resident. Repair of simple and complex abdominal hernias by the laparoscopic technique is now the method of choice in many centres. He recognized that inguinal hernias in children were probably congenital in nature and that they could be cured. A hernia is a protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it. If the hernia is large or lung becomes strangulated, surgery may be required lung hernia. Internal hernias can also be seen secondary to operative interventions. The number of these cases reported in literature is. 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 bernshteyn, i fendrich, m gianos, s szomstein, r j rosenthal. For some hernias, notably incisional and hiatal, the outcome appears to be superior using the minimally invasive. Most abdominal wall hernias should be evaluated by a surgeon when identified.
Rsna is committed to connecting radiologists and the radiology community to the most timely and useful covid19 information and resources. 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. Paraduodenal hernias, being the most common type of congenital internal hernias, are responsible for. Ge junction in normal position under diaphragm, fundus in chest. Paraduodenal hernias arise from a deficiency in midgut rotation. Sigmoidoscopy is no longer recommended as a screening test. In addition to the common inguinal hernias, both direct and indirect. Before 20 years, herniorrhaphy was considered for imaging of hernias. 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, including paraduodenal traditionally the most common, pericecal, foramen of winslow, and intersigmoid hernias, account for approximately 0. We report a case of small bowel obstruction due to right paraduodenal hernia in which all the known characteristic findings were demonstrated. 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.
Posttherapeutic adhesions of the small intestine were noted following surgical treatment and radiotherapy of two patients with wilms tumors. Authored by experienced radiologists and surgeons, imaging in abdominal surgery, by drs. Overview of abdominal wall hernias in adults uptodate. Left paraduodenal hernia hernia of lanzert is about three times more common than the right coun. 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. The possibility of diagnosis of paraduodenal hernia.
Internal hernias are uncommon in children and their clinical and imaging findings have not been widely addressed. Imaging studies are not required in the normal workup of a hernia 7, 8. The radiologic and arteriographic diagnostic signs of paraduodenal hernias, as based upon their anatomic features, are described and illustrated. Laparoscopic repair offers equivalent outcomes to open repair, with the additional benefits of greater patient satisfaction and reduced hospitalization.
Ct findings of right paraduodenal hernia presenting as. However, the incidence of postoperative internal hernias has been increasing recently. 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. Inguinal, femoral, umbilical, paraumbilical, richter, incisional, spigelian and obturator hernias hernia central. 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. 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. 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. Day in the life of an interventional radiology resident. This fossa is reported to be present in approximately 2% of autopsy bodies. Laparoscopic paraduodenal hernia repair sages abstract. The outer confines of the hernia sac are well defined.
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. They occur when the small bowel herniates into the paraduodenal fossa and can manifest as intestinal obstruction. Paraduodenal hernia pdh represents rare clinical entities based on few literatures. Federle and james lau, is a unique reference specially tailored to meet the needs of todays general surgeons. There are several different types of hernias types, symptoms, diagnosis and treatment.
Angiography may show altered configuration of the jejunal arteries. However it happens to be one of the common forms of internal herniation. Inguinal hernia in infancy and children intechopen. Right paraduodenal herniais due to entrapment of small bowel loops within the.
Written specifically for gastroenterologists at all levels, imaging in gastroenterolog, by drs. Approximately 400 years ago, a french surgeon named ambroise pare described the reduction of an incarcerated pediatric hernia and the application of trusses. We report the case of a left paraduodenal hernia as a. Laboratory studies are not specific for hernia but may be useful for general medical evaluation. Intestines, hernia intestines, ct 1department of radiology, taejon st marys hospital, the catholic university of korea, 2department of radiology, taejon armed forces general hospital. Importance of subject although internal hernias have an overall incidence of less than 1%, they constitute up to 5. 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. The two most common types, the left and right paraduodenal hernia involve small bowel herniating through a congenital opening in the mesenteries. One was diagnosed as paraduodenal hernia by ct and diagnosed was revealed by laparoscopy showing a single sac. Intestinal obstruction secondary to left paraduodenal hernia. 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. 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. Gastroesophageal ge junction and gastric cardia pass through esophageal hiatus paraesophageal rolling hernia. Both hernias present similarly, but have a differing embryological basis.
We present a case that underwent reduction via laparoscopy. Laparoscopic repair of obstructed left paraduodenal hernia dr. Buy meditex uriel hernia belt medium by uriel on free shipping on qualified orders. Abdominal wall hernias are typically classified by location or etiology. Paraduodenal hernias are the commonest type of internal hernia, affecting 23% of the population. Pericecal hernias dynamic radiology barnard health care. Review of clinical, imaging and surgical findings in 12 children with surgically proven ih. The patients had varied manifestations presenting with abdominal pain with or without vomiting and nausea and with or without signs of intestinal obstruction. Right small bowel followthrough demonstrates an ovoid cluster of mildly dilated jejunal segments in the left upper quadrant. We report five cases of paraduodenal hernia, all occurring in male patients ranging from 34 to 75 years of age. Here, the case of a 76yearold woman with a left paraduodenal hernia presenting with small bowel obstruction is presented, and a brief discussion of the literature on its diagnosis and management given. On anatomical and embryological basis, pdh can be broadly divided into right and left pdh. Poullos, and sidhartha sinha, is an authoritative, singlevolume resource that provides clear, relevant imaging information for th.
Treitz retroperitoneal hernia, hernia of the fossa of landzert, mesentericoparietal hernia of logace and hernia into the descending mesocolon of callader. We report the case of a left paraduodenal hernia as a coincidental finding in a patient who underwent a laparotomy for a suspected sigmoid tumour. The computed tomographic ct findings of a right and left paraduodenal hernia are described. To determine the spectrum of clinical and imaging findings of internal hernia ih in children and to highlight diagnostic features. 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. N2 an internal hernia is the protrusion of a viscus through a normal or abnormal opening within the confines of the abdominal cavity. The herniated bowel exerts mass effect on the greater curvature of the stomach, characteristic of a left paraduodenal hernia.
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. Eponymous abdominal hernias, part ii 1 department of radiology, umdnjnew jersey medical school, newark, nj, usa. 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. 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. Paraduodenal hernia is a relatively rare cause of acute abdomen, and its diagnosis is often incorrect or.
1072 1495 992 1 1224 760 1358 687 84 1351 559 185 1137 583 229 899 690 1227 1337 564 238 831 505 148 1194 353 1259 104 1488 498 6 995 1291 1487 1122 388 110 1224 1477 270 1372 630