title: Congenital left paraduodenal hernia causing chronic abdominal pain and abdominal catastrophe.
abstract: Paraduodenal hernias are the most common type of congenital internal hernia. Because of its overall rare incidence, this entity is often overlooked during initial assessment of the patient. Lack of specific diagnostic criteria also makes diagnosis exceedingly difficult, and the resulting diagnostic delays can lead to tragic outcomes for patients. Despite these perceived barriers to timely diagnosis, there may be specific radiographic findings that, when combined with the appropriate constellation of clinical symptoms, would aid in diagnosis. This patient first presented at 8 years of age with vague symptoms of postprandial emesis, chronic abdominal pain, nausea, and syncope. Over the span of 6 years he was evaluated 2 to 3 times a year with similar complaints, all of which quickly resolved spontaneously. He underwent multiple laboratory, imaging, and endoscopic studies, which were nondiagnostic. It was not until he developed signs of a high-grade obstruction and extremis that he was found to have a large left paraduodenal hernia that had volvulized around the superior mesenteric axis. This resulted in the loss of the entire superior mesenteric axis distribution of the small and large intestine and necrosis of the duodenum. In cases of chronic intermittent obstruction without clear etiology, careful attention and consideration should be given to the constellation of symptoms, imaging studies, and potential use of diagnostic laparoscopy. Increased vigilance by primary care and consulting physicians is necessary to detect this rare but readily correctable condition.
authors: Division of Pediatric Surgery, Department of Surgery, and M.E. DeBakey Department of Surgery, and.
authors: Yan
authors: Y
authors: Shi
authors: Division of Pediatric Surgery, Department of Surgery, and M.E. DeBakey Department of Surgery, and.
authors: Amy E
authors: AE
authors: Felsted
authors: Departments of Pediatric Radiology and Departments of Radiology and.
authors: Prakash M
authors: PM
authors: Masand
authors: Pediatric Hospital Medicine, Texas Children's Hospital, Houston, Texas; and Pediatrics, Baylor College of Medicine, Houston, Texas.
authors: Brent A
authors: BA
authors: Mothner
authors: Division of Pediatric Surgery, Department of Surgery, and M.E. DeBakey Department of Surgery, and.
authors: Jed G
authors: JG
authors: Nuchtern
authors: Division of Pediatric Surgery, Department of Surgery, and M.E. DeBakey Department of Surgery, and.
authors: J Ruben
authors: JR
authors: Rodriguez
authors: Division of Pediatric Surgery, Department of Surgery, and M.E. DeBakey Department of Surgery, and savasude@texaschildrens.org.
authors: Sanjeev A
authors: SA
authors: Vasudevan
mesh_terms: D015746:Abdominal Pain / Q000209:etiology* / Q000601:surgery; D002648:Child; D059350:Chronic Pain / Q000209:etiology* / Q000601:surgery; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D004378:Duodenal Diseases / Q000151:congenital* / Q000601:surgery; D046449:Hernia, Abdominal / Q000151:congenital* / Q000601:surgery; D006801:Humans; D045822:Intestinal Volvulus / Q000175:diagnosis* / Q000601:surgery; D007422:Intestines / Q000473:pathology / Q000601:surgery; D008297:Male; D009336:Necrosis; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D014057:Tomography, X-Ray Computed
keywords: chronic abdominal pain; computed tomography; internal hernia; paraduodenal hernia; transplant; volvulus