title: Laparoscopic treatment of acute small bowel obstruction due to left paraduodenal hernia: A case report and literature review.
abstract: BACKGROUND
  Internal hernia is a pathological condition resulting from abnormal protrusion of abdominal viscera through an opening in the intraperitoneal recesses of the abdominal cavity. Small bowel obstruction due to internal hernia is not common (0.25-0.9% of cases). The most common group is that of paraduodenal hernias (53%), of which the left-sided one is the most common type (75%).
  
  
  METHODS
  We report a case of a 43 year-old man with a history of recurrent abdominal pain, who was hospitalized because of an episode of acute small bowel obstruction. He had no previous surgery. Computed tomography revealed an encapsulated circumscribed cluster of jejunal loops in the left upper quadrant, near the ligament of Treitz, and the hernia orifice was adjacent to the left side of the inferior mesenteric vessels. Emergency laparoscopic surgery was performed: the small bowel was found completely herniated under the inferior mesenteric vessels. It was gradually reduced and the hernia space was closed with a running suture. The patient was discharged on the fourth day without complications.
  
  
  CONCLUSIONS
  Left paraduodenal hernia is a rare cause of small bowel obstruction that should be taken into account in a patient with a history of recurrent abdominal pain or intestinal obstruction, and no previous surgery. Computed tomography is the standard for a correct diagnosis. Surgery is treatment of choice, because it reduces the risk of emergency and complications associated to hernia. Laparoscopic approach is feasible and effective, also in emergency situation.
authors.affiliation: Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera-IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy. Electronic address: zizzomaurizio@gmail.com.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zizzo
authors.affiliation: Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera-IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy. Electronic address: nsmerieri@yahoo.it.
authors.forename: Nazareno
authors.initials: N
authors.lastname: Smerieri
authors.affiliation: Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera-IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy. Electronic address: Italo.Barbieri@asmn.re.it.
authors.forename: Italo
authors.initials: I
authors.lastname: Barbieri
authors.affiliation: Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera-IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy. Electronic address: andrealn1@yahoo.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lanaia
authors.affiliation: Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera-IRCCS Arcispedale Santa Maria Nuova, Avenue Risorgimento 80, 42123 Reggio Emilia, Italy. Electronic address: Stefano.Bonilauri@asmn.re.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonilauri
keywords: Laparoscopic treatment; Left paraduodenal hernia; Small bowel obstruction
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