Typically Imaged Incarcerated Left Paraduodenal Hernia -Onset and Course

• Published in: Nihon Kyukyu Igakukai Zasshi 1993/04/15, Vol.4(2), pp.158-162
• Main Authors: Koizumi, Jun, Shinozawa, Yotaro, Fujishima, Seitaro, Hori, Shingo, Izutsu, Mutsumu, Tashiro, Hiroichi, Aikawa, Naoki
• Format: Article
• Language: English
• Subjects: imaging; left paraduodenal hernia; PGE1
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.4.158

Internal herniae are mainly detected when they cause bowel obstruction but are responsible for less than one percent of bowel obstruction. Among these, approximately fifty percent are paraduodenal herniae. Although the preoperative diagnosis can be made radiographically, the findings can be subtle or even absent due to transition of the intestinal hernia. We experienced a 45-year-old man with paraduodenal internal hernia occurring on the left side of the duodenum, which was diagnosed by radiographic imaging including US, CT, angiography and barium study. He complained of severe epigastralgia with vomiting following a large meal on the previous night. CT showed the well-circumscribed bowel loops between the stomach and pancreas. Angiography revealed the jejunal arteries displaced to the left, crossing the inferior mesenteric vein, which seemed to outline the hernial ring. Immediately after angiography, the patient's symptoms disappeared, and CT after angiography revealed reduction of the intestinal loops. PGE1 and/or high-osmolarity contrast medium used during the study might have reduced tissue edema and been responsible for the relief of symptoms, unless the incarceration was reduced spontaneously.