PDF(Pubmed)
Abstract：
Paraduonenal hernia constitutes more than 50% of internal hernia cases. It can result in perilous sequelae like gut ischemia and perforation. We report a case of a patient who presented with acute intestinal obstruction and peritonitis and was diagnosed as a case of complicated paraduodenal as an incidental finding on laparotomy. A 26-year-old male patient presented with three days history of continuous severe incapacitating diffuse abdominal pain. The pain was associated with multiple episodes of bilious vomiting and absolute constipation. Patient had signs and symptoms of shock. Abdomen examination showed generalized peritonitis. Patient had deranged laboratory investigations. Abdominal X-ray showed acute intestinal obstruction. Patient was resuscitated and taken up for emergency laparotomy. Intraoperatively there was a long segment of gangrenous small bowel entrapped in the paraduodenal sac. Gangrenous gut was released from the sac and excised with proximal and distal ends fashioned as stoma through separate sites. Patient was managed with intravenous fluids with total parental nutrition. Patient gradually started on oral diet and jejunostomy output was refed through the distal stoma. Patient was discharged on postoperative day 14. Patient had uneventful early stoma closure at postoperative day 45 and now is on regular follow-up in the outdoor department. Paraduodenal hernias are one of the rare causes of intestinal obstruction that is difficult to diagnose. Radiologic investigation like abdominal computed tomography (CT) scan can aid in diagnosis of paraduodenal hernia. Surgeons should have clear knowledge about abnormal anatomy of internal hernias and complications they can face during surgery.
摘要：
腹侧疝占内部疝病例的50％以上。它可以导致危险的后遗症，如肠缺血和穿孔。我们报告了一例患有急性肠梗阻和腹膜炎的患者，并在剖腹手术中偶然发现了一例复杂的十二指肠旁。一名26岁的男性患者有三天的连续严重失能的弥漫性腹痛病史。疼痛与多次胆汁性呕吐和绝对便秘有关。患者有休克的体征和症状。腹部检查示全身性腹膜炎。患者的实验室检查混乱。腹部X线片显示急性肠梗阻。患者被复苏并接受紧急剖腹手术。术中有一段长的坏疽小肠包裹在十二指肠旁囊中。坏疽肠从囊中释放，并通过不同的部位切除近端和远端形成为造口。对患者进行静脉输液和总的父母营养管理。患者逐渐开始口服饮食，并通过远端造口重新进行空肠造口输出。患者在术后第14天出院。患者在术后第45天有顺利的早期造口关闭，现在正在户外部门进行定期随访。十二指肠旁疝是肠梗阻的罕见原因之一，难以诊断。诸如腹部计算机断层扫描（CT）扫描之类的放射学检查可以帮助诊断十二指肠旁疝。外科医生应该清楚了解内部疝的异常解剖结构以及他们在手术中可能面临的并发症。
