PANDORA’ S CUL DE SAC! pawartejaswinim91@gmail.com

PE030

PANDORA’ S CUL DE SAC!

4

 

 

 

 

India

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A paraduodenal hernia is a rare type of internal hernia, which results from anomalous rotation and reduction of the midgut loop in the embryo. The diagnosis is often difficult due to nonspecific symptoms

43 year old female presented with complaints of abdomen pain and vomiting since one day .Clinically vitals stable., abdomen soft mild epigastric tenderness . In view of persistant pain a CECT abdomen was done which revealed a large left paraduodenal hernia. She under went Laparoscopic reduction of the hernia with closure of hernial defect uneventfully.

Clinical symptoms of internal hernias depend on the degree of bowel protrusion and vascular involvement. Patients may be asymptomatic or present with mild chronic or intermittent abdominal pain, history of digestive disorders since childhood, nausea / vomiting or present with acute intestinal obstructions. CT scans are usually the imaging method of choice; Bowel loops can be found on CT scans, with a “sac-like” appearance, lying in the left anterior pararenal space, between the pancreas tail and the posterior wall of the stomach, to the left of the fourth duodenal portion. Because of the mass effect caused by crowding of bowel loops, there may be displacement of organs, mainly of the stomach (anteriorly), the duodenojejunal junction (inferiorly and medially), and the transverse colon (inferiorly) and the kidneys posteriorly as noted in our case. Diagnostic delays increase surgical complications, such as bowel obstruction, gangrene, and perforation.

Early surgical intervention and thorough anatomical knowledge is essential in missing such rare herniations and also untoward complications.