Sghaier Asma, El Ghali Mohamed Amine, Fradi Khalil, Chahed Mehdi, Hamila Fehmi, Youssef Sabri
Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia.
Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia.
Int J Surg Case Rep. 2023 Jul;108:108423. doi: 10.1016/j.ijscr.2023.108423. Epub 2023 Jun 17.
A paraduodenal hernia is a rare variety of hernia, however it is the most usual type of internal hernias. Clinical presentation is nonspecific. The clinical presentation is variable: indeed, the patient can be completely asymptomatic or present with symptoms which severity is variable according to the mechanism. The most common cause is an acute intestinal occlusion that could progress even to ischemia and intestinal necrosis. Depending on the clinical presentation and the suspected diagnosis, computed tomography can be of considerable help in demonstrating a para duodenal hernia.
We describe the case of a young man aged 18 years, who presented to the emergency unit with severe abdominal pain associated with incoercible vomiting. The surgical exploration had confirmed a para duodenal hernia responsible for an extensive necrosis of the small intestine allowing viable 90 cm only.
Paraduodenal hernias are rare and their diagnosis is not always easy. Therefore, they should be considered especially in the case of an occlusive syndrome occurring in a young patient who has never been operated on. If no treatment is undertaken, the evolution is drastic and the mortality rate is significant.
Successful surgical management requires knowledge of the intra-abdominal peritoneal spaces and management of suggestive clinical situations in order to reduce postoperative morbidity and mortality resulting from delayed diagnosis and treatment.
十二指肠旁疝是一种罕见的疝类型，但它是最常见的内疝类型。临床表现不具有特异性。临床表现多种多样：实际上，患者可能完全无症状，或者根据发病机制出现严重程度不同的症状。最常见的病因是急性肠梗阻，甚至可能进展为肠缺血和肠坏死。根据临床表现和疑似诊断，计算机断层扫描在显示十二指肠旁疝方面可能有很大帮助。
我们描述了一名18岁年轻男性的病例，他因严重腹痛伴无法控制的呕吐就诊于急诊科。手术探查证实为十二指肠旁疝，导致小肠广泛坏死，仅90厘米肠段存活。
十二指肠旁疝罕见，其诊断并不总是容易。因此，对于从未接受过手术的年轻患者出现闭塞综合征的情况，尤其应考虑到该病。如果不进行治疗，病情进展迅速，死亡率很高。
成功的手术治疗需要了解腹腔内的腹膜间隙并处理提示性的临床情况，以降低因诊断和治疗延迟导致的术后发病率和死亡率。
