Left paraduodenal hernia: a rare cause of small bowel obstruction in the elderly

Paraduodenal fossa hernias (PDFHs) represent 53% of all congenital internal hernias and 0.2-0.9% of all small bowel obstructions. Most of these hernias are diagnosed incidentally on laparotomy, and carry up to 50% lifetime risk of development of small bowel obstruction. We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia in a 17 year male, containing over 30% of the small bowel (jejunum and ileum), presenting with a history of recurrent incomplete small bowel obstruction. Plain abdominal radiography showed distended loops of jejunum and few air fluid levels. After laparotomy and identification of hernia, small gut was reduced and examined, which was found to be structurally and functionally intact with normal vascularity. The defect was closed with continuous absorbable suture (Vicryl 2-0) sparing the inferior mesenteric vessels. Patient’s post-operative recovery remained uneventful and he was discharged on 4th post-operative day.

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Small Bowel Obstruction in the Elderly

Principles and Practice of Geriatric Surgery ◽

10.1007/978-3-319-20317-1_64-1 ◽

2017 ◽

pp. 1-21

Author(s):

William F. Morano ◽

Wilbur B. Bowne

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

The Elderly

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Closed loop bowel obstruction secondary to left paraduodenal hernia (of Landzert)

BMJ Case Reports ◽

10.1136/bcr-2019-232134 ◽

2019 ◽

Vol 12 (12) ◽

pp. e232134

Author(s):

Yeo Min Cho ◽

Gamze Aksakal ◽

Mohamed Ahmed Tawfik Ashour ◽

Suzanne Moore

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Rare Case ◽

Closed Loop ◽

Flank Pain ◽

Paraduodenal Hernia ◽

Good Recovery ◽

Left Colic Artery ◽

Unusual Phenomenon

A 34-year-old man presented with acute severe left-sided abdominal and flank pain with associated postprandial nausea and vomiting. CT imaging revealed findings suspicious for a closed loop small bowel obstruction. Intraoperative findings were that of a left paraduodenal hernia (of Landzert) secondary to a mesenteric defect immediately posterior to the ascending branch of the left colic artery. The defect was closed via minilaparotomy. Unfortunately, his postoperative course was complicated by small bowel obstruction which required further laparotomy and adhesiolysis. The patient eventually made a good recovery. Here, we present a rare case of intestinal obstruction and discuss the aetiologies and management of this unusual phenomenon.

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The Diagnostic Yields and Safety of Double-Balloon Enteroscopy in Obscure Gastrointestinal Bleeding and Incomplete Small Bowel Obstruction: Comparison between the Adults and Elderly

Gastroenterology Research and Practice ◽

10.1155/2020/8121625 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Lei Wang ◽

Mengfan Xie ◽

Liwen Hong ◽

Chen Zhang ◽

Tianyu Zhang ◽

...

Keyword(s):

Postoperative Complications ◽

Small Bowel ◽

Gastrointestinal Bleeding ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

The Elderly ◽

Obscure Gastrointestinal Bleeding ◽

Double Balloon Enteroscopy ◽

Balloon Enteroscopy ◽

Double Balloon

Background. Double-balloon enteroscopy (DBE) is widely used worldwide. However, comparisons between the diagnostic yields in adults and the elderly remain scarce. Aim. The aim of this study is to compare the diagnostic yields and safety of DBE between adults and elderly with obscure gastrointestinal bleeding and incomplete small bowel obstruction. Method. We retrospectively reviewed patients who underwent DBE with indication of obscure gastrointestinal bleeding or incomplete small bowel obstruction in Ruijin Hospital and classified them into adults (18–64 years old) and elderly (≥65 years old). Clinical characteristics, diagnostic yields, and postoperative complications were collected and further analyzed. Results. A total of 877 DBE procedures, 729 in adults and 148 in the elderly, were performed. In the patients with OGIB, the adults showed a higher frequency of Meckel’s diverticulum compared with the elderly (4.6% vs. 0.9%, P=0.032). Angioectasia was higher in frequency in the elderly than in the adults (25.9% vs. 17.9%, P=0.048). In patients with incomplete small bowel obstruction, the elderly were more likely to have adenocarcinoma than the adults (19.4% vs. 7.1%, P=0.038). The adults had higher tendency to have Crohn’s disease than the elderly (23.4% vs. 8.3%, P=0.045). Most of the postoperative complications were mild. The adults and elderly displayed comparable tolerance to DBE (P>0.05) Conclusion. DBE has a high diagnostic yield in small bowel disorders, and a slight difference in disease spectrum was observed between the adults and elderly. DBE can be well-tolerated in the elderly.

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An Unusual Cause of Small Bowel Obstruction in a Pediatric Patient: Right-Sided Paraduodenal Hernia

The American Surgeon ◽

10.1177/000313481808400903 ◽

2018 ◽

Vol 84 (9) ◽

pp. 350-351

Author(s):

Doris Kim ◽

Bennett Calder ◽

Alexander Smith ◽

Christian Streck

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Pediatric Patient ◽

Bowel Obstruction ◽

Paraduodenal Hernia

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Small Bowel Obstruction in the Elderly

Principles and Practice of Geriatric Surgery ◽

10.1007/978-1-4419-6999-6_63 ◽

2011 ◽

pp. 793-805

Author(s):

Kelley A. Sookraj ◽

Wilbur B. Bowne

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

The Elderly

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What is the Rate of Small Bowel Obstruction after Colectomy?

The American Surgeon ◽

10.1177/000313480807401026 ◽

2008 ◽

Vol 74 (10) ◽

pp. 1001-1005 ◽

Cited By ~ 4

Author(s):

Janak A. Parikh ◽

Clifford Y. Ko ◽

Melinda A. Maggard ◽

David S. Zingmond

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Group Versus ◽

The Elderly ◽

The United States ◽

First Year ◽

Surgery Group ◽

History Of ◽

Common Operation

The rate of small bowel obstruction (SBO) after colectomy is unknown. Given the large number of colectomies performed in the United States, elucidating SBO rates, outcomes, and identifying predictors of readmission is important. Using the California Inpatient File, we identified all patients readmitted with a principle diagnosis of SBO at least once in the 3 years after colectomy (n = 4555). Patients admitted with a diagnosis of SBO in the 3 years before surgery were excluded. Overall, 10 per cent of patients were readmitted for SBO at least once after colectomy. Approximately 58 per cent were readmitted in the first year and 22 per cent of these patients required surgery. The most common operation performed was lysis of adhesions. Median length of stay was twice as long in the surgery group versus the no surgery group (12 vs 6 days). Overall mortality was higher in the nonsurgery group compared with the surgery group (33% vs 21%, P < 0.001) and highest in the elderly (44% vs 30%, P < 0.001). One in 10 patients without a history of SBO who undergoes a colectomy will be readmitted at least once in the subsequent 3 years for SBO, and there is a high mortality rate in this group, especially in the elderly.

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