Shrestha Samrat, Ghimire Sabin K, Shrestha Mecklina, Maharjan Suresh, Ghimire Rabin Kumar
National Academy of Medical Sciences, NAMS, Bir Hospital, Department of General Surgery, Kathmandu, Province-3, Nepal.
College of Medical Sciences(CoMS), Department of Pathology, Bharatpur, Province-3, Nepal.
Int J Surg Case Rep. 2025 Aug 26;135:111858. doi: 10.1016/j.ijscr.2025.111858.
Paraduodenal hernias (PDH) are the most common type of internal hernia, accounting for 53 % of cases, but remain a rare cause of intestinal obstruction overall. Left PDH, comprising about 75 % of all PDHs, can present with vague gastrointestinal symptoms or acute obstruction, with a high risk of strangulation and bowel ischemia. Early diagnosis and prompt surgical management are essential to reduce morbidity and mortality.
A 51-year-old male presented with abdominal distention, vague abdominal pain, bilious vomiting, and inability to pass stool or flatus. Contrast-enhanced computed tomography revealed a closed-loop obstruction due to a left PDH. Emergency laparotomy showed herniation of jejunal and ileal loops with a 3 cm segment of nonviable jejunum, which was resected. An end-to-end anastomosis and primary repair of the defect were performed. The postoperative course was uneventful, and the patient remained symptom-free at the six-month follow-up.
Left PDH arises from congenital defects in the mesocolon, typically through the fossa of Landzert. Diagnosis is challenging due to nonspecific symptoms, but can be accurately made with CT imaging. Surgical intervention-open or laparoscopic-is required due to the high risk of complications. The approach depends on clinical urgency and available expertise.
Left PDH, though rare, must be considered in cases of unexplained obstruction, especially in a virgin abdomen. Early CT diagnosis and prompt surgical intervention are vital to reducing morbidity and mortality. The surgical approach should be tailored to patient stability and available expertise.
十二指肠旁疝（PDH）是最常见的内疝类型，占所有病例的53%，但总体上仍是肠梗阻的罕见病因。左位PDH约占所有PDH的75%，可表现为模糊的胃肠道症状或急性梗阻，发生绞窄和肠缺血的风险很高。早期诊断和及时的手术治疗对于降低发病率和死亡率至关重要。
一名51岁男性出现腹胀、腹部隐痛、胆汁性呕吐以及无法排便或排气。增强CT显示因左位PDH导致的闭袢性肠梗阻。急诊剖腹探查显示空肠和回肠袢疝出，有一段3cm的空肠坏死，予以切除。进行了端端吻合和缺损的一期修复。术后过程顺利，患者在六个月随访时无症状。
左位PDH源于结肠系膜的先天性缺陷，通常通过Landzert隐窝。由于症状不具特异性，诊断具有挑战性，但CT成像可准确做出诊断。由于并发症风险高，需要进行手术干预——开放手术或腹腔镜手术。手术方式取决于临床紧迫性和现有专业技能。
左位PDH虽然罕见，但在不明原因肠梗阻的病例中必须予以考虑，尤其是在未做过腹部手术的患者中。早期CT诊断和及时的手术干预对于降低发病率和死亡率至关重要。手术方式应根据患者的稳定性和现有专业技能进行调整。
