Congenital left paraduodenal hernia causing chronic abdominal pain and abdominal catastrophe.

Abstract:

:Paraduodenal hernias are the most common type of congenital internal hernia. Because of its overall rare incidence, this entity is often overlooked during initial assessment of the patient. Lack of specific diagnostic criteria also makes diagnosis exceedingly difficult, and the resulting diagnostic delays can lead to tragic outcomes for patients. Despite these perceived barriers to timely diagnosis, there may be specific radiographic findings that, when combined with the appropriate constellation of clinical symptoms, would aid in diagnosis. This patient first presented at 8 years of age with vague symptoms of postprandial emesis, chronic abdominal pain, nausea, and syncope. Over the span of 6 years he was evaluated 2 to 3 times a year with similar complaints, all of which quickly resolved spontaneously. He underwent multiple laboratory, imaging, and endoscopic studies, which were nondiagnostic. It was not until he developed signs of a high-grade obstruction and extremis that he was found to have a large left paraduodenal hernia that had volvulized around the superior mesenteric axis. This resulted in the loss of the entire superior mesenteric axis distribution of the small and large intestine and necrosis of the duodenum. In cases of chronic intermittent obstruction without clear etiology, careful attention and consideration should be given to the constellation of symptoms, imaging studies, and potential use of diagnostic laparoscopy. Increased vigilance by primary care and consulting physicians is necessary to detect this rare but readily correctable condition.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Shi Y,Felsted AE,Masand PM,Mothner BA,Nuchtern JG,Rodriguez JR,Vasudevan SA

doi

10.1542/peds.2014-3701

subject

Has Abstract

pub_date

2015-04-01 00:00:00

pages

e1067-71

issue

4

eissn

0031-4005

issn

1098-4275

pii

peds.2014-3701

journal_volume

135

pub_type

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