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左十二指肠旁疝:反复发作性腹痛的罕见病因:病例报告。

Left paraduodenal hernia: a rare cause of recurrent abdominal pain: case report.

机构信息

Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.

Umm Al-Qura University, Mecca, Saudi Arabia.

出版信息

Pan Afr Med J. 2021 Nov 3;40:135. doi: 10.11604/pamj.2021.40.135.32065. eCollection 2021.

Abstract

Internal hernias are quite rare, accounting for fewer than 1% of all abdominal hernias. Moreover, the most frequent cause of internal herniation is paraduodenal hernia (PDH). Diagnosing paraduodenal hernias can be difficult due to the wide range of symptoms that can occur. It is a case report of paraduodenal hernia that was diagnosed and managed in a tertiary center. We describe the case of a 55-year-old male patient who had been experiencing nonspecific abdominal discomfort for the last 5 years and had several comorbidities and positive serology. An abdominal computed tomography (CT) revealed that he had a left PDH, which was effectively treated with laparoscopic surgical repair. The study's strength is that it was correctly identified by CT and subsequently laparoscopically corrected. A gastrografin swallow study was also performed postoperatively to ensure there was no leak. The study's flaw is that the patient was misdiagnosed for five years in other medical facilities. Because paraduodenal hernia is an uncommon diagnosis, it's important to keep it in mind as one of the differential diagnoses for persistent discomfort. It also needs accurate imaging in order to identify and successfully manage it. To demonstrate the relevance of this uncommon condition, future research is needed to report on any misdiagnosis or treatment. To conclude, nowadays the best option for paraduodenal hernia repair is laparoscopic surgery. However, because it can present with a wide variety of symptoms and diagnosis might be challenging, it demands a high index of suspicion. The gold standard for identifying paraduodenal hernia is still a CT scan of the abdomen. Patients who are stable and have no signs of intestinal obstruction might decide to have their hernia repaired to avoid future problems. To demonstrate the relevance of this uncommon condition, future research is needed to report on any misdiagnosis or treatment.

摘要

内疝较为罕见,不到所有腹部疝的 1%。此外,内疝最常见的原因是十二指肠旁疝(PDH)。由于可能出现的症状范围广泛,诊断 PDH 可能具有挑战性。这是在三级中心诊断和治疗 PDH 的病例报告。我们描述了一位 55 岁男性患者的病例,他在过去 5 年中一直经历非特异性腹部不适,并且有多种合并症和阳性血清学。腹部计算机断层扫描(CT)显示他患有左侧 PDH,通过腹腔镜手术修复有效治疗。该研究的优势在于它通过 CT 正确识别,并随后通过腹腔镜纠正。术后还进行了胃造影吞咽研究以确保无泄漏。该研究的缺陷在于该患者在其他医疗机构被误诊了五年。由于 PDH 是一种不常见的诊断,因此将其作为持续不适的鉴别诊断之一非常重要。为了准确识别和成功治疗,还需要准确的成像。为了证明这种罕见情况的相关性,需要进行未来的研究报告任何误诊或治疗。总之,目前 PDH 修复的最佳选择是腹腔镜手术。但是,由于它可能表现出多种症状,并且诊断可能具有挑战性,因此需要高度怀疑。识别 PDH 的金标准仍然是腹部 CT 扫描。对于没有肠梗阻迹象且稳定的患者,可能会决定修复疝以避免未来出现问题。为了证明这种罕见情况的相关性,需要进行未来的研究报告任何误诊或治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1c68/8641634/680629791162/PAMJ-40-135-g001.jpg

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