Cengiz Merve Busra, Hasbahceci Mustafa, Cipe Gokhan, Karatepe Oguzhan, Muslumanoglu Mahmut
Department of General Surgery, Bezmialem Vakıf University Faculty of Medicine, İstanbul, Turkey.
Ulus Travma Acil Cerrahi Derg. 2013 Nov;19(6):573-5. doi: 10.5505/tjtes.2013.30776.
Paraduodenal hernia, the most common type of internal herniation, is rare in the etiology of intestinal obstruction. Delayed diagnosis and surgical intervention may result in significant morbidity and mortality risk. This report presents a case of left paraduodenal hernia resulting in acute intestinal obstruction. A 43-year old male patient was admitted with a diagnosis of acute intestinal obstruction. A left paraduodenal hernia was identified by computed tomography findings of an encapsulated cluster of dilated small bowel loops occupying the left upper quadrant between the stomach and pancreas, and the presence of an engorged and displaced vascular pedicle at the orifice of the hernia. Upon further investigation, the dilated proximal jejunal segments were found in the left paraduodenal fossa, enclosed in a hernia sac. After reducing the intestinal segments to the abdominal cavity, the orifice of the hernia sac was closed by suturing to the retroperitoneum. Paraduodenal hernia should be considered as a possible etiology in cases of acute intestinal obstruction with unremarkable presentations. Physicians should be familiar with the demonstrative imaging findings of computed tomography of a paraduodenal hernia. Early surgical intervention is critical to prevent the significant morbidity and mortality associated with this condition.
十二指肠旁疝是最常见的内疝类型，在肠梗阻病因中较为罕见。诊断延迟和手术干预可能导致显著的发病率和死亡风险。本报告介绍了一例导致急性肠梗阻的左十二指肠旁疝病例。一名43岁男性患者因急性肠梗阻入院。通过计算机断层扫描发现，扩张的小肠袢聚集形成包块，占据胃和胰腺之间的左上腹，且疝孔处有充血移位的血管蒂，据此确诊为左十二指肠旁疝。进一步检查发现，扩张的近端空肠段位于左十二指肠旁隐窝，被包裹在疝囊内。将肠段还纳腹腔后，通过缝合至腹膜后关闭疝囊孔。对于临床表现不明显的急性肠梗阻病例，应考虑十二指肠旁疝这一可能病因。医生应熟悉十二指肠旁疝的计算机断层扫描特征性影像学表现。早期手术干预对于预防与该疾病相关的显著发病率和死亡率至关重要。
