title: Clinical importance of duodenal recesses with special reference to internal hernias.
abstract: BACKGROUND
  The detailed knowledge of the peritoneal recesses has great significance with respect to internal hernias. The recesses are usually related to rotation and adhesion of abdominal viscera to the posterior abdominal wall and/or the presence of retroperitoneal vessels which raises the serosal fold. The duodenal recesses are usually related to the 3rdand 4thparts of the duodenum. Internal hernias with respect to these recesses are difficult to diagnose clinically and usually noticed at the time of laparotomy. So, the knowledge of these recesses can be valuable to abdominal surgeons.
  
  
  METHODS
  The present study was conducted in 100 cases including 10 cadavers, 45 post mortem cases and 45 cases undergoing laparotomy.
  
  
  RESULTS
  We found superior and inferior duodenal recesses in 28% and 52% respectively, paraduodenal in 12%, mesentericoparietal in 3%, retroduodenal in 2% and duodenojejunal in 18% of cases. Two abnormal duodenojejunal recesses were found, one on the right (instead of the left) of the abdominal aorta, and in the other the opening was directed upwards instead of downwards. The incidence of internal hernias was 3%.
  
  
  CONCLUSIONS
  Thus it was observed that there is low incidence of superior and inferior duodenal recesses, and high incidence of paraduodenal recess. The abnormal recesses might be due to malrotation of the gut. In laparotomy cases, the internal hernia was noticed when the abdomen was opened for intestinal obstruction. The incidence of internal hernia was found to be high.
authors.affiliation: Department of Anatomy, Government Medical College, Nagpur, India.
authors.forename: Shivpal V
authors.initials: SV
authors.lastname: Tambe
authors.affiliation: Department of Anatomy, Maulana Azad Medical College, New Delhi, India.
authors.forename: Kum Kum
authors.initials: KK
authors.lastname: Rana
authors.affiliation: Department of General Surgery, Maulana Azad Medical College, New Delhi, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Kakar
authors.affiliation: Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India.
authors.forename: Satish
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: Department of Forensic Medicine and Toxicology, Maulana Azad Medical College, New Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Aggrawal
authors.affiliation: Department of Anatomy, Maulana Azad Medical College, New Delhi, India.
authors.forename: Smita
authors.initials: S
authors.lastname: Kakar
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, Raipur, India.
authors.forename: Nitinkumar
authors.initials: N
authors.lastname: Borkar
keywords: internal hernias; peritoneal recesses; retroperitoneal vessels