Laparoscopic repair of a right paraduodenal hernia.
OBJECTIVE
Right paraduodenal hernia (PDH) results from a primitive gut malrotation. The resultant jejunal mesenteric defect posterior to the superior mesenteric vessels allows decompressed jejunum to herniate retroperitoneally. PDH make up 53% of all internal hernias, but account for only 0.2% to 5.8% of all cases of intestinal obstruction. In addition, PDH exhibits male and left-sided predominance. Ours is the second report to describe the preoperative diagnosis and totally laparoscopic repair of a right PDH.


METHODS
We report the case of a 26-year-old female with symptoms suggestive of partial small bowel obstruction and a 6-year history of intermittent abdominal pain. Physical examination demonstrated lower quadrant tenderness. Plain abdominal radiographs and ultrasonography were nondiagnostic. Contrasted computed tomography of the abdomen revealed jejunum encased within the right upper quadrant suspicious for right PDH.


RESULTS
The patient underwent successful laparoscopic right PDH repair and was discharged home on postoperative day 1 without late sequelae.


CONCLUSIONS
In the outpatient setting, clinical suspicion and comprehensive radiological investigation permit preoperative diagnosis of right PDH. In acute situations, clinical presentation, plain radiographs, and then diagnostic laparoscopy may be an expeditious diagnostic algorithm. Subsequent laparoscopic repair of right PDH is feasible and may shorten hospital length of stay.
Bittner
James G
JG
Department of Surgery, Medical College of Georgia, Augusta, Georgia 30912, USA.
Edwards
Michael A
MA
Harrison
Steven J
SJ
Li
Kelvin
K
Karmin
Paul N
PN
Mellinger
John D
JD
D000328:Adult; D004378:Duodenal Diseases / Q000196:embryology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006547:Hernia / Q000175:diagnosis / Q000196:embryology; D059685:Herniorrhaphy; D006801:Humans; D007583:Jejunum / Q000033:anatomy & histology; D010535:Laparoscopy; D011028:Pneumoperitoneum, Artificial