Shah Dimpy, Borle Nitin, Suryawanshi Sachin
General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, IND.
Cureus. 2024 Sep 11;16(9):e69192. doi: 10.7759/cureus.69192. eCollection 2024 Sep.
Paraduodenal hernias, especially right sided, are extremely rare entities that are difficult to diagnose due to their uncommon presentation. Some may experience small bowel obstruction. Such patients will have a guarded prognosis if complicated by sepsis due to strangulation or perforation. Hereby, we present a case report of a 15-year-old male who presented with a three-hour history of severe colicky abdominal pain. A computed tomography scan revealed acute small bowel obstruction. On laparotomy, it was found that the majority of the small bowel loops were obstructed in a sac on the right side of duodenojejunal flexure and had become gangrenous, suggesting strangulated right paraduodenal hernia. Due to extensive small bowel resection, this patient succumbed in the postoperative period. This case demonstrates how complex the diagnosis and management of this entity are, as well as how fatal the outcomes can be. Early diagnosis and surgical intervention remain the mainstay of treatment.
十二指肠旁疝，尤其是右侧十二指肠旁疝，是极为罕见的疾病，因其临床表现不常见而难以诊断。部分患者可能会出现小肠梗阻。若因绞窄或穿孔并发脓毒症，此类患者的预后不佳。在此，我们报告一例15岁男性病例，该患者有3小时严重绞痛性腹痛病史。计算机断层扫描显示急性小肠梗阻。剖腹探查时发现，大部分小肠袢在十二指肠空肠曲右侧的一个囊内受阻，并已发生坏疽，提示为绞窄性右侧十二指肠旁疝。由于广泛的小肠切除，该患者在术后死亡。本病例展示了该疾病的诊断和治疗是多么复杂，以及后果可能是多么致命。早期诊断和手术干预仍然是治疗的主要手段。
