Khedr Sayed, Abdelmohsen Sarah Magdy, Abdelazim Osama
Lecturer of Pediatric Surgery at Cairo University Children Hospital, Cairo University, Egypt.
Lecturer of Pediatric Surgery, Aswan University Hospital, Aswan University, Egypt.
Int J Surg Case Rep. 2024 Jun;119:109696. doi: 10.1016/j.ijscr.2024.109696. Epub 2024 Apr 25.
Paraduodenal hernias are difficult to diagnose due to their unusual presentation. Herein, five new cases are added to the literature.
Four male and one female child complained of paraduodenal hernias, two on the right side and three on the left side. The intestinal part that herniated inside the hernia sac was also malrotated in four patients. One patient had Meckel's diverticulum with a herniated intestine. One infant had extrahepatic biliary disease, a single atrium, polysplenia, intestinal malrotation, and a left paraduodenal hernia. Exploratory labarotomy was done for reduction of the intestine, reorientation, and repair of hernia orifices.
Paraduodenal hernia is a component of malrotation. Cautious dissection of the hernia orifice is required to keep away from injuries to the inferior mesenteric vein or left colic artery in the course of the restoration of the left paraduodenal hernia. Also, the superior mesenteric vessels may be injured in the course of the restoration of the right paraduodenal hernia.
There is a correlation between the occurrence of PDH with malrotation. The diagnosis of malrotation can be made with an ultrasound abdomen; however, it is true that ultrasound cannot make a confirmed diagnosis in all patients. Once the diagnosis of a mesocolic hernia has occurred, surgical repair is mandatory by closure of the defect.
十二指肠旁疝因其不寻常的表现而难以诊断。本文在此基础上为文献增添了5例新病例。
4名男性和1名女性儿童主诉患有十二指肠旁疝，其中右侧2例，左侧3例。4例患者疝囊内疝入的肠段也发生了旋转不良。1例患者患有梅克尔憩室并伴有肠疝入。1例婴儿患有肝外胆道疾病、单心房、多脾、肠旋转不良和左侧十二指肠旁疝。进行了剖腹探查术以复位肠管、重新定向并修复疝孔。
十二指肠旁疝是旋转不良的一个组成部分。在修复左侧十二指肠旁疝的过程中，需要谨慎解剖疝孔以避免损伤肠系膜下静脉或左结肠动脉。此外，在修复右侧十二指肠旁疝的过程中，肠系膜上血管可能会受到损伤。
十二指肠旁疝的发生与旋转不良之间存在关联。腹部超声可用于诊断旋转不良；然而，超声确实无法对所有患者做出确诊。一旦诊断为结肠系膜疝，必须通过闭合缺损进行手术修复。
