Laparoscopic Surgical Intervention for Pediatric Paraduodenal Hernia: Overview and Literature Review of a Rare Cause of Abdominal Pain and Obstruction.

Abstract

Paraduodenal Hernia (PDH) is an extremely rare cause of bowel obstruction. The true incidence of pediatric PDH is unknown since there are very few published cases of this phenomenon. PDH carries a high morbidity and mortality rate if unidentified. Proper diagnosis and prompt surgical intervention are extremely important. Our case is of a healthy 3-year-old male who presented with six days of generalized abdominal pain associated with constipation, anorexia, insomnia, and non-bloody, non-bilious emesis. Abdominal ultrasound (US) was negative for intussusception and failed to visualize the appendix. Abdominal x-ray (AXR) showed nonspecific distention of several loops of bowel with air-fluid levels. Computerized tomography (CT) scan was concerning for an internal hernia versus possible transverse colonic volvulus. The patient's abdominal pain and distension worsened after nasogastric (NG) tube placement. With the combination of physical and imaging findings, the patient underwent diagnostic laparoscopy. Intraoperatively, severely dilated bowel was encountered, which was decompressed via the appendix. After which, we discovered a PDH on the left side of the ligament of Treitz which was successfully reduced. The patient had no complications and continues tolerating a regular diet with return of normal bowel function. Our case describes successful laparoscopic surgical reduction of a pediatric left paraduodenal hernia.