Mary E Huerter, MD, MA, Caroline Hudson, BS, Eduardo Smith-Singares, MD, FACS. University of Illinois at Chicago
PURPOSE: Paraduodenal hernias are a type of uncommon cogenital internal hernia. Their clinical presentation is typically nonspecific. Acurate diagnosis is critical as the risk of strangulation can be as high as 50% with an exceedingly high mortality of up to 50%.
METHODS: We present a case of a 77 year-old woman with a history of congestive heart failure, atrial fibrillation, pulmonary fibrosis, AICD placement, hysterectomy and cholecystectomy, who was transferred from an outside hospitalwhere she was admitted for a congestive heart failure exacerbation and sustained a traumatic femoral arterial line placement.
She became peritonitic during her hospitalization and was taken emergently to the operating room. The small bowel was found to be herniated under the inferior mesenteric vessels. She had dense adhesions extending into the pelvis. A hernia sac was identified near the fourth portion of the duodenum, consistent with a paraduodenal hernia. The hernia was reduced and the hernia space (Landzert’s fossa) was closed with interrupted silk suture. There were some necrotic portions of sigmoid colon that were resected. The patient was left in disconinuity due to her critical status. The patient subsequently returned to the operating room for further resection and creation of an end ileostomy. She was ultimately closed at her fourth operation. The patient had an extended intensive care course, but showed no further signs of obstruction for the remainder of her hosptialization.
CONCLUSION: Paraduodenal hernias are a relatively uncommon cause of an acute surgical abdomen. Diagnosis is often challenging due to its vague clinical presentation and variable radiologic manifestation. Prompt surgical intervention has the potential to minimize the significant morbidity and mortality associated with a missed or delayed diagnosis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87921
Program Number: P056
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster