Asian Journal of Case Reports in Surgery

A Retrospective Analysis of Paraduodenal Internal Hernia: A Case Series of Nine Patients

S. N. Jatal *

Jatal Hospital and Research Centre, Latur, India.

Sudhir Jatal

Jatal Hospital and Research Centre, Latur, Tata Hospital, Mumbai, India.

Supriya Jatal

MGM Hospital & College, Navi Mumbai, India.

*Author to whom correspondence should be addressed.

---

Abstract

Internal abdominal hernias are a rare condition, making up only 0.9% of all cases of intestinal obstruction. Among these, Paraduodenal hernias are exceptionally rare, comprising approximately 53% of all internal hernias. They are more frequently found in the left Paraduodenal fossa compared to the right, have a higher incidence in males and are primarily congenital in nature.

A Left Paraduodenal hernia represents a congenital defect situated posterior to the inferior mesenteric vein and the left branches of the middle colic artery, located to the left of the fourth part of the duodenum. Most patients are diagnosed with this condition between their fourth and sixth decades of life. Delay in diagnosis can lead to surgical complications such as bowel obstruction, gangrene, and perforation. The preferred imaging method for diagnosis is typically a CT scan. The treatment of choice is either an open exploratory laparotomy or laparoscopic surgery.

In this report, we present findings from nine cases of Left Paraduodenal hernias with management involving exploratory laparotomy for seven adult patients and laparoscopic surgery for two paediatric cases.

Keywords: Paraduodenal hernia, internal hernia, strangulation of small bowel

---

---

---

References

Hassani KI, Aggouri Y, Laalim SA, Toughrai I, Mazaz K. Left paraduodenal hernia: A rare cause of acute abdomen. Pan Afr Med J. 2014 Mar 27;17:230. DOI: 10.11604/pamj.2014.17.230.3546 PMID: 25170374; PMCID: PMC4145264.

Shadhu, K., Ramlagun, D. & Ping, X. Para-duodenal hernia: a report of five cases and review of literature. BMC Surg. 2018; 18(32). Available:https://doi.org/10.1186/s12893-018-0365-8

Kuzinkovas V, Haghighi K, Singhal R, Andrews NJ. Paraduodenal hernia: A rare cause of abdominal pain. Can J Surg. 2008 Dec;51(6):E127-8. PMID: 19057724; PMCID: PMC2592587.

Dragan Manojlović, Nenad Čekić, Mario Palinkaš, Left paraduodenal hernia – A diagnostic challenge: Case report, International Journal of Surgery Case Reports. Available:https://doi.org/10.1016/j.ijscr.2021.106138

Maheshwari, S., Khadka, A., Bhattacharjee, S. et al. A case report of left paraduodenal hernia with a spontaneous reduction on follow-up: The rare demonstration on computed tomography. Egypt J Radiol Nucl Med. 2020;51: 224. Available:https://doi.org/10.1186/s43055-020-00338-4

Okino Y, Kiyosue H, Mori H, et al. Root of the small-bowel mesentery: correlative anatomy and CT features of pathologic conditions. Radio Graphics. 2001;21:1475-1490.

Gabriele Giordano, Elena La Mirata, Valentina Politi, Massimiliano Veroux , Gaetano Alfio Meli, Left Paraduodenal Hernia in a Young Patient with Recurrent Abdominal Pain: A Case Report and Short Literature Review. Am J Case Rep. 2022;23:e935413. DOI: 10.12659/AJCR.935413

Cundy TP, Di Marco AN, Hamady M, et al Giant left paraduodenal hernia Case Reports. 2014;2014:bcr2013202465.

Xu H, Nie N, Kong F, Zhong B. Large left paraduodenal hernia with intestinal ischemia: A case report and literature review. Journal of International Medical Research. 2020;48(9). DOI:10.1177/0300060520955040

Vanmali A, Maharajh J, Haines M. Left paraduodenal hernia: Embryological and radiological findings. S Afr. J Rad. 2021;25(1):a1979. Available:https://doi.org/10.4102/sajr. v25i1.1979