J Korean Surg Soc.  2009 Nov;77(5):362-365. 10.4174/jkss.2009.77.5.362.

Laparoscopic Repair of Left Paraduodenal Hernia

• Kim BS
• Lim YA
• Jang KM
• Kim IG
• Jeon JY

• KMID: 1750707
• DOI: http://doi.org/10.4174/jkss.2009.77.5.362

Abstract

Internal abdominal hernia is an unusual cause of intestinal obstruction. Paraduodenal hernia is relatively rare congenital malformations resulting from incomplete rotation of the midgut with entrapment of the small intestine beneath the developing colon. We report a case of paraduodenal hernia treated by laparoscopic approach. The patient was a 45-year-old man presenting with severe abdominal pain for 5 hours. Left paraduodenal hernia with jejunum hernia containing jejunal loops showed in abdominal CT. At operation, herniation of the small intestine into a retroperitoneal space through a defect on the left mesocolon was noted. After the herniated bowel was fully reduced, the hernia orifice was closed intra-corporeally in the manner of interrupted sutures with absorbable suture materials. The patient was discharged home without any serious complications on postoperative day 9. Conclusively, we think laparoscopic surgery in left paraduodenal hernia is feasible.

Keyword

Abdominal hernia; Intestinal obstruction; Laparoscopic surgery

MeSH Terms

Abdominal Pain
Colon
Hernia
Hernia, Abdominal
Humans
Intestinal Obstruction
Intestine, Small
Jejunum
Laparoscopy
Mesocolon
Middle Aged
Retroperitoneal Space
Sutures

Figure

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  Fig. 1 Radiologic findings of paraduodenal hernia. (A) Abdomen plain radiograph demonstrates a mass-like density and mild dilated small bowel loops in left upper abdomen. (B) Contrast-enhanced axial CT scan of the upper abdomen shows a sac-like mass of aggregated jejunal loops between the pancreatic head and descending colon. The inferior mesenteric vein (arrows) is located at the anterior border of the encapsulated jejunal loops. J: jejunal loops, P: Pancreatic head, D: descending colon.

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  Fig. 2 Operative findings after reduction of the herniated bowel. The hernia orifice is observed near the ligament of Treitz and medial to the inferior mesenteric vein and ascending left colic artery.

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  Fig. 3 Repair of paraduodenal hernia. The hernia orifice is closed intra-corporeally in the manner of interrupted sutures with 3-0 vicryl.

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