Kaitlin Edwards, MD1, Brianna Greenberg2, Ashley Vergis, MMed, MD, FRCSC, FACS1. 1University of Manitoba, 2University of Limerick Ireland
We present a case of a 26-year-old male with a 1-day history of dull, aching abdominal pain radiating to his back as well as intermittent episodes of nausea, vomiting, and bloating over the past two years. With limited explanation from his benign abdominal exam, CT imaging suggested a diagnosis of right paraduodenal hernia, where the small bowel becomes trapped between the ascending mesocolon and posterior peritoneum (Waldeyer’s Fossa) due to a congenital malrotation of the midgut during embryological development. Right paraduodenal hernias may cause acute or chronic symptoms of obstruction or ischemia of the incarcerated small bowel. The true prevalence of paraduodenal hernias is not well known, as many patients remain asymptomatic.
Our patient was managed surgically with a laparoscopic lateral approach. Beginning with mobilization of the right colon from its lateral retroperitoneal attachments, we widely opened, and thereby obliterated, the hernia sac. An appendectomy was performed given the non-anatomic location of the cecum in the left abdomen. Our patient did well post-operatively and was discharged home the same day.
In conclusion, laparoscopy is a safe and effective management option for right paraduodenal hernia repair. The lateral approach may be of benefit when Waldeyer’s Fossa is not readily apparent or when the surgeon is unable to reduce the small bowel due to adhesions. This method eliminates any future risk of herniation, as compared to suture closure, which may make it the preferred approach for right paraduodenal hernias.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95427
Program Number: V093
Presentation Session: Exhibit Hall Theater Video Session IV
Presentation Type: EHVideo