Paraduodenal hernias in children: Etiology, treatment, and outcomes of a rare but real cause of bowel obstruction

Abstract

Introduction: Paraduodenal Hernia (PDH) is the most common variant of internal hernia and occurs most often in males during their 4^th-6^th decades of life. PDH in pediatric age group has rarely been reported in literature with only five cases of age up to 10 years were reported. PDH is a rare cause of intestinal obstruction, which may lead to subsequent strangulation and perforation of the bowel.

Presentation of case: We reported a 1.5 year-old male child presented with intestinal obstruction. The patient experienced abdominal pain, vomiting and irritability. Abdominal x-ray showed distal intestinal obstruction which was discovered to be a result of left PDH incidentally during the surgery. In addition, we performed a literature search using PubMed to identify the published cases of PDH. We also compared our case with the characteristics of all reported PDHs in toddlers and children up to 10 years of age in a concise table.

Discussion: Despite its congenital origin, PDH has been reported in childhood age group in very rare occasions rendering the accurate incidence of PDH in infancy and childhood unknown. PDHs can be asymptomatic or can present most commonly with recurrent upper abdominal pain. Diagnosis is quite difficult in the absence of symptoms but could be achieved using a computed tomography (CT-scan) in non-emergency symptomatic patients. Surgical repair is mandatory to avoid potential complications.

Conclusion: As PDH can lead to major and life threatening complications, it must remain in our minds as a possible cause of intestinal obstruction.

Keywords: Internal hernia; Intestinal obstruction; Left; Paraduodenal hernia; Pediatric.

Fig. 1

Initial radiological imaging for the child (A) Plain abdominal x-ray shows multiple air-fluid levels, and (B) Barium enema shows a complete obstruction in the mid transverse colon.

Fig. 2

Intraoperative photograph shows the left paradudenal hernial sac.

Fig. 3

Intraoperative photographs (A) while reducing the sac contents into the abdomen cavity, and (B) closing the defect.