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Schizas D, Apostolou K, Krivan S, Kanavidis P, Katsaros I, Vailas M, Koutelidakis I, Chatzimavroudis G, Pikoulis E. Paraduodenal hernias: a systematic review of the literature. Hernia 2019; 23:1187-1197. [PMID: 31006063 DOI: 10.1007/s10029-019-01947-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Paraduodenal hernias (PDH), also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0.2-0.9% of all cases of intestinal obstruction. This is the first systematic review of all reported cases so far, investigating their clinical presentation, radiological imaging, and treatment outcomes. METHODS After a detailed search in PubMed and Medline, using the keywords "paraduodenal hernia", 115 studies matched our criteria. A review of these reports was conducted and the full texts were examined. RESULTS A total of 159 patients were included in our analysis, with 69.8% and 30.2% of them suffering from either a left or a right PDH, respectively. Mean age at diagnosis was 44.1 years, with a 2/1 male/female ratio. PDH were associated with non-specific symptoms and signs; abdominal pain being the most common. Computed tomography (CT) scan of the abdomen was the most frequently used diagnostic modality. Regardless of PDH localization, all patients were operated on, with approximately one-third of them undergoing a laparoscopic operation, which was associated with a significantly decreased morbidity rate as well as length of hospital stay, compared with the open repair. CONCLUSIONS PDH are not usually associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of knowledge and clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair, seeming to be the optimum treatment strategy.
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Affiliation(s)
- D Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - K Apostolou
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece.
| | - S Krivan
- Department of Upper Gastrointestinal and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, UK
| | - P Kanavidis
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - I Katsaros
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - M Vailas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Ag. Thoma 17 Str., Goudi, Athens, 11527, Greece
| | - I Koutelidakis
- Second Department of Surgery, G.Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - G Chatzimavroudis
- Second Department of Surgery, G.Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - E Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Alila M, Marouni A, Toughrai I. [Left paraduodenal hernia: a rare cause of bowel obstruction]. Pan Afr Med J 2017; 28:32. [PMID: 29138668 PMCID: PMC5680996 DOI: 10.11604/pamj.2017.28.32.13497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 11/11/2022] Open
Abstract
We here report two cases of acute bowel obstruction. Emergency intervention showed left obstructive paraduodenal hernia causing volvulus with necrosis of the incarcerated intestinal loops in one patient who underwent one-time anastomosis resection and suffering but viable small bowel in the second patient treated by incarcerated intestinal loop reduction and obturation of the orifice of the hernial canal. We here highlight the diagnostic and therapeutic features of this rare condition.
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Affiliation(s)
- Mohammed Alila
- Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Hassan II de Fès, Maroc
| | - Abdelouahab Marouni
- Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Hassan II de Fès, Maroc
| | - Imane Toughrai
- Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Hassan II de Fès, Maroc
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Erdas E, Pitzalis A, Scano D, Licheri S, Pomata M, Farina G. Diagnosis and treatment of symptomatic right paraduodenal hernia: report of a case. Surg Today 2013; 44:192-6. [PMID: 23325494 DOI: 10.1007/s00595-012-0483-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 07/03/2012] [Indexed: 11/25/2022]
Abstract
We report a typical case of right paraduodenal hernia (RPH) and review the literature on the pathogenesis, diagnosis and treatment of this uncommon entity. A 32-year-old woman was hospitalized with acute abdominal cramps, nausea, and vomiting. Computed tomography (CT) findings suggested RPH, which was confirmed by explorative laparoscopy. We performed an open repair by suturing the orifice after reducing the hernia. At her 2-year follow-up, the patient reported complete resolution of her symptoms. Because RPH is rare and its clinical signs are nonspecific, radiological examinations are essential for a correct preoperative diagnosis. CT is currently the most accurate diagnostic tool, but laparoscopy may be necessary to confirm the diagnosis. This hernia can be repaired by simple suturing of the hernial orifice, either laparoscopically or via an open procedure, although several authors consider complete intestinal derotation to be the best option.
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Affiliation(s)
- Enrico Erdas
- 1st Institute of General Surgery, San Giovanni di Dio Hospital, University of Cagliari, Cagliari, Italy,
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Catalano OA, Bencivenga A, Abbate M, Tomei E, Napolitano M, Vanzulli A. Internal hernia with volvulus and intussusception: case report. ACTA ACUST UNITED AC 2004; 29:164-5. [PMID: 15290940 DOI: 10.1007/s00261-003-0122-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
An 82-year-old male presented to the hospital because of acute exacerbation of abdominal pain and biliary vomiting. Contrast-enhanced computed tomography of the abdomen was performed. A left paraduodenal hernia associated with volvulus, intussusception, and bowel wall ischemia were radiologically diagnosed. Surgery confirmed the diagnostic imaging findings. We present the first case of an association of these acute abdominal conditions.
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Affiliation(s)
- O A Catalano
- Diagnostica per Immagini, A. O. Rummo, Via Provinciale 93, Beltiglio di Ceppaloni (BN), Benevento 82010, Italy.
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Moran JM, Salas J, Sanjuán S, Amaya JL, Rincón P, Serrano A, Tallo EM. Paramesocolic hernias: consequences of delayed diagnosis. Report of three new cases. J Pediatr Surg 2004; 39:112-6. [PMID: 14694386 DOI: 10.1016/j.jpedsurg.2003.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND If internal hernias account for less than 1% of the causes of intestinal obstruction, the paraduodenal or paramesocolic hernias (PMH) represent 50% of the 500 published as of the year 2000. Despite their congenital character, they are diagnosed more frequently in adulthood, with a mean age of 38 years at diagnosis. In the last few years, diagnoses are being made earlier. With the goal of increased early diagnosis and decreased mortality associated with these internal hernias, the authors report on 3 young patients with PMH. METHODS Three cases of paramesocolic hernias are reported, 2 right (RPMH) and 1 left (LPMH). They all had a history of symptoms of recurrent abdominal pain of variable frequency and intensity but of sufficient importance to justify previous diagnostic studies. The 2 patients with RPMH, a 3-year-old boy and a 17-year-old woman, presented symptoms of intestinal obstruction and had necrosis of the small intestine leading to short-bowel syndrome. The LPMH patient, a 13-year-old boy, suffered recurrent abdominal pain from the age of 3. Gastroesophageal reflux was diagnosed, and surgery was performed at the age of 4 years. A laparoscopy at 13 years of age found no pathology. A new upper gastrointestinal tract series found retroperitoneal and paraduodenal jejunum incarceration, partially obstructing the duodenum. During surgery, the adhered jejunal section was restored intraperitoneally, and the open Treitz arch was closed. The authors have not found the anatomic characteristics of this case in the literature. CONCLUSIONS Delays and errors in PMH diagnosis may result in irreparable damage. Differential diagnosis workups of patients with recurrent abdominal pain syndrome should always include PMH.
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Affiliation(s)
- Jose M Moran
- University Department of Surgery and Pediatric Surgery, Faculty of Medicine, University Hospital Infanta Cristina, University of Extremadura, Badajoz, Spain
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