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      Laparoscopic management of left paraduodenal hernia

      case-report
      ,
      Journal of Minimal Access Surgery
      Medknow Publications
      Paraduodenal hernia, laparsocopy, internal hernia

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          Abstract

          Internal herniation of small bowel accounts for about 1% of all the patients with intestinal obstruction. Fifty percent of the patients with paraduodenal hernia will have bowel obstruction. Left paraduodenal hernia resulting from abnormal rotation of the midgut during embryonic development is the most common form of congenital internal hernia. A case of a young male presenting with chronic abdominal pain due to left paraduodenal hernia is being reported. A correct preoperative diagnosis of left paraduodenal hernia was made on computerised tomography (CT), and the patient was managed by laparoscopic surgery. The role of imaging in preoperative diagnosis is being highlighted with a brief review of literature.

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          Most cited references10

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          Congenital and acquired internal hernias: unusual causes of small bowel obstruction.

          Fourteen cases of small bowel obstruction caused by congenital or postoperative internal herniation of bowel and treated at the University and Veterans Administration Medical Centers, Jackson, Mississippi between 1970 and 1983 were reviewed retrospectively. Of the total, eight were congenital (three transomental, two paraduodenal, one foramen of Winslow, one ileocecal transmesenteric, and one paracecal) and six acquired (three transmesenteric, one behind a Roux-Y esophagojejunostomy, one behind a Roux-Y pancreaticojejunostomy, and one between limbs of an end colostomy mucous fistula). Gangrenous bowel was present at exploration in nine cases (64 percent, five congenital and four acquired). In no case was a correct preoperative diagnosis of incarcerated or strangulated internal hernia made. In each patient, except for one who died before celiotomy could be performed, reduction of the hernia contents, resection of necrotic bowel, primary anastomosis or, on occasion, enterostomy, and correction of the anatomic defect leading to the herniation were performed. Postoperative mortality was 31 percent (four patients). Each of the four patients had presented initially with gangrenous bowel. The clinical features and management of congenital and acquired internal hernias have been reviewed and correlated with therapeutic outcome. In addition, the difficulties in diagnosis and the features of various types of these hernias have been discussed with comments made regarding prevention of the acquired forms of these rare hernias, along with the embryologic background and methods of management of the various congenital defects.
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            The surgical management of paraduodenal hernia.

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              Paraduodenal hernia: diagnosis and surgical management.

              Paraduodenal hernia is an unusual cause of intestinal obstruction, but one with which all surgeons should be familiar. We reviewed the anatomy, pathophysiology, initial symptoms, radiographic criteria for diagnosis, and subsequent therapy of five patients treated for paraduodenal hernia at Walter Reed Army Medical Center. Contrast radiography of the small intestine remains the mainstay of preoperative diagnosis. Essential components of treatment include bowel reduction and obliteration of the hernia defect by simple closure or by wide opening of the sac. Further recommendations include sparing the inferior mesenteric vessels during the repair of left paraduodenal hernias and transpositioning the right colon to the left side of the abdomen for repair of right paraduodenal hernias.
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                Author and article information

                Journal
                J Minim Access Surg
                JMAS
                Journal of Minimal Access Surgery
                Medknow Publications (India )
                0972-9941
                1998-3921
                Oct-Dec 2010
                : 6
                : 4
                : 122-124
                Affiliations
                Department of Surgery, Parmar Nursing Home, Ropar, Punjab, India
                Author notes
                Address for correspondence: Dr. BPS Parmar, Parmar Nursing Home, Bela Road, Ropar, Punjab, India. E-mail: bpsparmar@ 123456yahoo.co.in
                Article
                JMAS-6-122
                10.4103/0972-9941.72601
                2992663
                21120072
                004c547b-c04f-4b4a-abfb-2b9b1b4bb632
                © Journal of Minimal Access Surgery

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 January 2010
                : 29 April 2010
                Categories
                Unusual Case

                Surgery
                internal hernia,paraduodenal hernia,laparsocopy
                Surgery
                internal hernia, paraduodenal hernia, laparsocopy

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