A Bernshteyn, I Fendrich, M Gianos, S Szomstein, R J Rosenthal. Cleveland Clinic Florida
Background: Paraduodenal hernias in adults are rare. We present a case that underwent reduction via laparoscopy.
Methods: A 39 year old male with new onset of severe abdominal pain presented to the ER with clinical signs and symptoms of bowel obstruction. The patient had several past similar episodes that resolved spontaneously. Physical exam was consistent with localized LUQ tenderness but no peritoneal signs. A CT scan of the abdomen demonstrated early small bowel obstruction possibly due to an internal hernia. The patient underwent a diagnostic laparoscopy. During the procedure a left paraduodenal hernia was identified. After reduction of the small bowel into the normal anatomic position, abnormal adhesions were lysed, with partial mobilization of the ligament of Treitz. The defect was then left unclosed and small bowel was run distally to ensure no down stream causes of obstruction.
Results: The postoperative period was uneventful. The patient was discharged home on post operative day two tolerating regular diet, with no complaints and all symptoms resolved.
Conclusion: Laparoscopic reduction of paraduodenal hernia appears to be a feasible and safe approach for the treatment of early proximal small bowel obstruction
Program Number: V049