Pdf right paraduodenal hernia pdh results from a primitive gut malrotation. Discuss the imaging features of various types of internal hernias. An internal hernia ih is defined as the protrusion of abdominal viscera, most. What is a hernia ultrasound a hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it. Associated stretching and distortion of mesenteric vessels. Congenital left paraduodenal hernia causing chronic abdominal pain and abdominal catastrophe yan shi, md a,b, amy e. Correlation of imaging and surgical findings1 clinical diagnosis of internal hernias is challenging because of their nonspecific signs and symptoms.
One such hernia is paraduodenal hernia which can be either on the left or right of the duodenum and occurs through an unusual peritoneal recess into the retroperitoneum. The patients had varied manifestations presenting with abdominal pain with or without vomiting and nausea and with or without signs of intestinal obstruction. However, unlike malrotation, the duodenum crosses the midline and the cecum is located in the right lower quadrant. Right paraduodenal hernia an imaging diagnosis eurorad. Paraduodenal hernias, which are a type of internal hernia, occur due to malrotation of midgut and form a potential space near the ligament of treitz. The two most common types, the left and right paraduodenal hernia involve small bowel herniating through a congenital opening in the mesenteries.
Abdominal wall hernias are typically classified by location or etiology. Internal hernias in the era of multidetector ct rsna publications. Paraduodenal hernias pdh, also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0. A hernia is a protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it. Doctors give unbiased, trusted information on the use of imaging for hiatal hernia. Medical records, including mdct images and intraoperative findings. Ct is the imaging modality of choice in diagnosing a paraduodenal hernia. The history and physical examination are usually sufficient to make the diagnosis.
Imaging ct abdomen and pelvis is a good imaging modality to assess for abdominal hernia, especially when there is concern for acute incarceration or strangulation. Internal hernias, including paraduodenal traditionally the most common, pericecal, foramen of winslow, and intersigmoid hernias, account for approximately 0. Although most abdominal hernias are asymptomatic, the fear of developing complications like. An enlarged inguinal lymph node can mimic an incarcerated inguinal hernia, and surgical exploration may occasionally be necessary to confirm the diagnosis. Paraduodenal hernia pdh represents rare clinical entities based on few literatures. Proper repair of right paraduodenal hernia has been described by bartlett et al. Paraduodenal herniact wednesday, july 22, 2009 ct, duodenum, git, hernia, radiology intestinal obstruction is a common clinical condition that is usually suspected on the basis of clinical signs and patient history. Usually, total or subtotal internal herniation of the small bowel loops is recognized readily, but insufficient attention has been given to the frequency and clinical significance of small paraduodenal hernias. Paraduodenal hernias are very rare, but they account for about 30%53% of all internal hernias. In the clinical literature, only a few cases of paraduodenal hernia diagnosed with computed tomography ct have been reported. Paraduodenal hernias are rare congenital internal hernias accounting for a case report r. The majority of presentations occur between the 4th and 5th decades of life.
The hernia ultrasound is a noninvasive diagnostic exam that captures images of the major structures involved in the hernia. Paraduodenal hernia is a rare congenital malformation. However, the incidence of postoperative internal hernias has been increasing recently. Abnormal location of small bowel loops within the left hemiabdomen, lying in the left anterior pararenal space. Paraduodenal hernias are the commonest type of internal hernia, affecting 23% of the population. Internal hernia is, either congenital or acquired, a rare cause of smallbowel obstruction, with a reported incidence of less than 2%. An internal hernia is defined as a hernia formed by the protrusion of a viscus through a peritoneal or mesenteric aperture, leading to its encapsulation within a compartment of the abdominal cavity.
Paraduodenal hernia pdh, though uncommon, is a surgical emergency associated with high risk of strangulation and incarceration. Diagnosis of pdh was based on either radiological imaging or intraoperative surgical findings. Recently, laparoscopic surgery has been increasingly performed in abdominal procedures. By using a bolustracking program, arterial phase scanning was. Clinical features of paraduodenal hernia yu jun wong.
Paraduodenal hernias frequently present subtle findings on barium contrast studies. Laparoscopic repair is reasonable in patients who have a. The ectopic small bowel is contained within a hernia sac, which is outlined by ascites. Clinical and imaging findings in 17 patients with emphasis on ct criteria.
Abdominal wall hernias are usually suggested by the patients history and confirmed by physical examination. A ct scan of a left paraduodenal hernia usually demonstrates clustering of loops of small bowel at or above the ligament of treitz or behind the stomach, causing a mass effect on the posterior wall. This is a retrospective case series of pdh diagnosed in singapore general hospital sgh. P araduodenal hernia, also called mesocolic hernia, is a type of internal hernia that is thought to be caused by a congenital defect involving abnormal retroperitoneal fixation of the mesentery due to abnormal rotation of the midgut. Herniation of the small bowel through the paraduodenal mesenteric fossa of landzert. Internal hernias remain one of the most challenging and potentially frustrating diagnoses that face abdominal imagers. The management of paraduodenal hernia consists of reduction of the herniated intestine and repair of the defect. Early reports utilizing ct in diagnosing internal hernia started almost at. The computed tomographic ct findings of a right and left paraduodenal hernia are described. Symptomatic patients often have groin pain, which can sometimes be severe. Ge junction in normal position under diaphragm, fundus in. Findings are consistent with left paraduodenal hernia. It is most commonly observed in the abdomen but can also occur in the upper thigh, belly button, and groin. Vasudevan, md paraduodenal hernias are the most common type of congenital internal hernia.
Paraduodenal hernia pdh is defined as abnormal herniation of the small bowel into the paraduodenal fossa. Classic ct features include an encapsulated cluster of small bowel loops located between the pancreatic bodytail and the stomach. Lack of specific diagnostic criteria also makes diagnosis exceedingly difficult, and the resulting diagnostic delays can lead to tragic outcomes for patients. To evaluate the feasibility and efficacy of laparoscopic. Although it may be an incidental finding at autopsy or at laparotomy, some cases are symptomatic. Paraduodenal hernia, mesocolic hernia, internal hernia, intestinal malrotation, embryology, small bowel obstruction, gastrointestinal radiology. Paraduodenal hernia is a congenital internal hernia caused by abnormal retroperitoneal fixation of the intestinal mesentery. Diagnosis of pdh was based on radiological or intraoperative surgical findings. The herniated bowel exerts mass effect on the greater curvature of the stomach, characteristic of a left paraduodenal hernia. Ct findings include a zone of transition depicting a change in diameter of small bowel from dilated to a normal or decreased diameter such as the pinch point seen in the. Paraduodenal hernias arise from a deficiency in midgut rotation. A case of strangulated ileus caused by intramesosigmoid hernia with left paraduodenal hernia nihon rinsho geka gakkai zasshi journal of japan surgical association, vol.
Gastroesophageal ge junction and gastric cardia pass through esophageal hiatus paraesophageal rolling hernia. The nature of the repair depends upon the size and location of the. Clinical features of paraduodenal hernia yu jun wong, narayan lath, alvin kim hock eng, and vikneswaran navasivayam proceedings of singapore healthcare 2017 27. How to check for a hernias happens when an area of the muscle wall holding your internal organs in place becomes weakened. Eight pdhs were identified during the study period. Inguinal hernias are one of the most common reasons a primary care patient may need referral for surgical intervention.
Laparoscopic paraduodenal hernia repair sages abstract. Preoperative diagnosis of right paraduodenal hernia by. When presentation and examination suggest a diagnosis other than hernia or hydrocele, appropriate imaging, including ultrasonography, may be necessary. Webmd explains the symptoms of hernias and when to seek medical care images for hernia right side. Paraduodenal hernias are the most common type of congenital internal hernia.
Friday exhibit hall video presentations session 1 held during the 2017 sages annual meeting in houston, tx on friday, march 24, 2017. Right small bowel followthrough demonstrates an ovoid cluster of mildly dilated jejunal segments in the left upper quadrant. Paraduodenal hernias, although uncommon, have classically been the most common type of internal hernia. Most abdominal wall hernias should be evaluated by a surgeon when identified. Clinical features of paraduodenal hernia yu jun wong, narayan.
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. Because of its overall rare incidence, this entity is often overlooked during initial assessment of the patient. Importance of subject although internal hernias have an overall incidence of less than 1%, they constitute up to 5. The paraduodenal hernia is a congenital internal hernia that occurs through an mesenteric defect there are 2 types of paraduodenal hernia. The outer confines of the hernia sac are well defined. Once the weakened area becomes large enough, a part of the internal organ starts. A case of sliding right paraduodenal hernia in a 52 years old woman with chronic postprandial pain. Pdf laparoscopic repair of a right paraduodenal hernia. Internal hernia ihrelated surgical acute abdomen is not well understood. Overview of abdominal wall hernias in adults uptodate. We report five cases of paraduodenal hernia, all occurring in male patients ranging from 34 to 75 years of age.
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