Ulus Travma Acil Cerrahi Derg. 2013; 19(6): 573-575 | DOI: 10.5505/tjtes.2013.30776

Acute intestinal obstruction secondary to left paraduodenal hernia: a case report

Merve Busra Cengiz, Mustafa Hasbahceci, Gokhan Cipe, Oguzhan Karatepe, Mahmut Muslumanoglu
Bezmialem Vakif University Faculty Of Medicine Dept Of General Surgery

Background: Paraduodenal hernia, as the most common type of internal herniation, is a rare etiology for acute intestinal obstruction. Any delay in diagnosis and surgical intervention may be important for high morbidity and mortality.
Methods: This report presents a case of left paraduodenal hernia causing an acute intestinal obstruction.
Results: A 43-year old male patient admitted with a diagnosis of acute intestinal obstruction. Left paraduodenal hernia was diagnosed by computed tomography findings of an encapsulated cluster of dilated small bowel loops occupying mainly left upper quadrant between stomach and pancreas, and engorged and displaced vascular pedicle at orifice of hernia. On exploration, dilated proximal jejunal segments were found in left paraduodenal fossa which was enclosed in a hernia sac. After reducing intestinal segments to abdominal cavity, orifice of hernia sac was closed by suturing to retroperitoneum.
Conclusion: Paraduodenal hernia should be thought as a possible etiology for acute intestinal obstruction because of its unremarkable presentation. Physicians should be familiar to demonstrative imaging findings of paraduodenal hernia taken by computed tomography. Early surgical intervention is very important to avoid morbidity and mortality associated with this condition.

Keywords: Intestinal obstruction, internal hernia, paraduodenal hernia

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Sol paraduodenal herniye ikincil akut intestinal obstruksiyon: olgu sunumu

Merve Busra Cengiz, Mustafa Hasbahceci, Gokhan Cipe, Oguzhan Karatepe, Mahmut Muslumanoglu
Bezmialem Vakýf Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalý

Amaç: Paraduodenal herni, internal herninin en sýk görülen tipi olarak akut intestinal obstruksiyonun nadir bir sebebidir. Taný ve cerrahi tedavideki gecikmeler yüksek morbidite ve mortalite için önemli olabilir.
Gereç ve Yöntem: Bu yazýda akut intestinal obstruksiyona sebep olan bir sol paraduodenal herni olgusu sunulmaktadýr.
Bulgular: Kýrk üç yaþýndaki bir erkek hasta akut intestinal obstruksiyon ön tanýsý ile baþvurdu. Bilgisayarlý tomografide saptanan, mide ile pankreas arasýnda özellikle sol üst kadraný dolduran enkapsüle dilate ince barsak segmentleri kümesi ve herni açýklýðýnda bulunan geniþlemiþ ve yer deðiþtirmiþ ince barsak vasküler pedikülü bulgularý ile sol paraduodenal herni tanýsý kondu. Eksplorasyonda, sol paraduodenal fossa yerleþimli bir herni kesesi içerisinde sýnýrlanmýþ dilate proksimal ince barsak segmentlerinin olduðu görüldü. Barsak segmentleri karýn içi boþluða redükte edildikten sonra, herni açýklýðý retroperitona dikilerek kapatýldý.
Sonuç: Paraduodenal herni, belirgin olmayan baþvuru þekli nedeniyle akut intestinal obstruksiyonun olasý bir sebebi olarak düþünülmelidir. Hekimler bilgisayarlý tomografi ile elde edilebilen tanýsal görüntüleme bulgularýna aþina olmalýdýr. Erken cerrahi giriþim, bu hastalýk ile iliþkili morbidite ve mortalitenin azaltýlmasý için önemlidir.

Anahtar Kelimeler: Ýntestinal obstruksiyon, internal herni, paraduodenal herni

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