Tavasolizadeh Morteza, Dalili Amin
Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of General Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Int J Surg Case Rep. 2024 Sep;122:110055. doi: 10.1016/j.ijscr.2024.110055. Epub 2024 Jul 18.
Introduction and importance: Paraduodenal hernias (PDHs) are congenital internal hernias. Overall, internal hernias are between 0.2 % and 0.9 %, while 53 % of these statistics are for PDH. There are left and right types of PDHs.
An otherwise healthy 26-year-old man was presented with a sudden-onset epigastric and right upper quadrant abdominal pain. Abdominopelvic double contrasted CT scan revealed multiple dilated proximal-mid small bowel loops in the portal venous phase consistent with small bowel obstruction, suggesting concomitant bowel malrotation with internal paraduodenal hernia. The patient with the pre-operative diagnosis of small bowel obstruction due to volvulus was scheduled for emergency surgery. He was four weeks complication-free in his regular follow-up.
In 1857, Treitz first described PDH as a phenomenon when the primitive midgut in embryonic life abnormally rotates and causes mesocolic hernia. The location of the duodenal recess is the origin point for describing the hernia; thus, the jejunum is the most common herniating viscus. However, the stomach, small intestine, and sometimes the colon usually consist of the contents of the hernia.
In the absence of surgical history, abdominal wall hernia, and intra-abdominal inflammatory disease, in case of repeated abdominal pain or intestinal obstruction, and if no other causes are found, the possibility of a PDH should be kept in mind.
引言与重要性：十二指肠旁疝（PDH）是先天性腹内疝。总体而言，腹内疝占比在0.2%至0.9%之间，其中53%为十二指肠旁疝。十二指肠旁疝有左右两种类型。
一名26岁健康男性突发上腹部和右上腹疼痛。腹盆腔双重对比CT扫描显示门静脉期多个近端至中段小肠袢扩张，符合小肠梗阻，提示合并肠旋转不良伴十二指肠旁内疝。术前诊断为肠扭转导致小肠梗阻的患者被安排进行急诊手术。他在定期随访中四周无并发症。
1857年，Treitz首次将十二指肠旁疝描述为胚胎期原始中肠异常旋转并导致结肠系膜疝的一种现象。十二指肠隐窝的位置是描述该疝的起始点；因此，空肠是最常见的疝入脏器。然而，疝内容物通常包括胃、小肠，有时还有结肠。
在没有手术史、腹壁疝和腹内炎症性疾病的情况下，若反复出现腹痛或肠梗阻，且未发现其他病因，应考虑十二指肠旁疝的可能性。
