A Case of Left Paraduodenal Hernia Difficult to Diagnose Preoperatively

Haruno Satoshi, Fukuta Atsuhisa, Kawakubo Naonori, Obata Satoshi, Nagata Kouji, Matsuura Toshiharu, Tajiri Tatsuro

doi:10.11164/jjsps.58.7_978

<p>A six-year-old boy was admitted to the pediatric department of our hospital because of abdominal and chest pains. Blood test findings on admission showed elevated CRP and LDH levels. The patient was referred to our department because of worsening abdominal pain after admission. Abdominal computed tomography showed left-sided deviation of the small intestine with wall thickening and poor fixation of the colon. Because of the rapid progression of the abdominal pain, torsion of the small intestine or internal hernia was suspected, and emergency laparotomy was performed. The surgical findings included venous congestion in the jejunum and a 13 × 16 × 65 mm Landzert fossa, and we diagnosed the patient as having a left paraduodenal hernia. There was no evidence of intestinal necrosis, and the operation was completed with the closure of the hernia gate. Postoperatively, the patient developed paralytic ileus and required conservative treatment. The patient was discharged from the hospital 24 days after the operation without symptom recurrence. Although it has been recently reported that the finding of a sac-like appearance on CT images is useful for the diagnosis of paraduodenal hernia, it was difficult to detect in our patient preoperatively. It was suggested that it was necessary to recognize left paraduodenal hernia as one of the differential indicators of acute abdomen.</p>

A Case of Left Paraduodenal Hernia Difficult to Diagnose Preoperatively

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