Paramesocolic hernias: consequences of delayed diagnosis. Report of three new cases.
BACKGROUND
If internal hernias account for less than 1% of the causes of intestinal obstruction, the paraduodenal or paramesocolic hernias (PMH) represent 50% of the 500 published as of the year 2000. Despite their congenital character, they are diagnosed more frequently in adulthood, with a mean age of 38 years at diagnosis. In the last few years, diagnoses are being made earlier. With the goal of increased early diagnosis and decreased mortality associated with these internal hernias, the authors report on 3 young patients with PMH.


METHODS
Three cases of paramesocolic hernias are reported, 2 right (RPMH) and 1 left (LPMH). They all had a history of symptoms of recurrent abdominal pain of variable frequency and intensity but of sufficient importance to justify previous diagnostic studies. The 2 patients with RPMH, a 3-year-old boy and a 17-year-old woman, presented symptoms of intestinal obstruction and had necrosis of the small intestine leading to short-bowel syndrome. The LPMH patient, a 13-year-old boy, suffered recurrent abdominal pain from the age of 3. Gastroesophageal reflux was diagnosed, and surgery was performed at the age of 4 years. A laparoscopy at 13 years of age found no pathology. A new upper gastrointestinal tract series found retroperitoneal and paraduodenal jejunum incarceration, partially obstructing the duodenum. During surgery, the adhered jejunal section was restored intraperitoneally, and the open Treitz arch was closed. The authors have not found the anatomic characteristics of this case in the literature.


CONCLUSIONS
Delays and errors in PMH diagnosis may result in irreparable damage. Differential diagnosis workups of patients with recurrent abdominal pain syndrome should always include PMH.
Moran
Jose M
JM
University Department of Surgery and Pediatric Surgery, Faculty of Medicine, University Hospital Infanta Cristina, University of Extremadura, Badajoz, Spain.
Salas
Jesus
J
Sanjuán
Santiago
S
Amaya
Jose L
JL
Rincón
Paloma
P
Serrano
Antonio
A
Tallo
Emilia M
EM
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D002675:Child, Preschool; D003951:Diagnostic Errors; D004378:Duodenal Diseases / Q000175:diagnosis; D005260:Female; D006555:Hernia, Ventral / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis*; D007415:Intestinal Obstruction / Q000209:etiology; D007421:Intestine, Small / Q000002:abnormalities; D008297:Male