術前診断が可能であった左傍十二指腸ヘルニアの１例

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  • A CASE OF LEFT PARADUODENAL HERNIA DIAGNOSED PREOPERATIVELY

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We report a case of left paraduodenal hernia diagnosed preoperatively. A 13-year-old boy admitted for left upper abdominal pain, nausea, and vomiting was found in abdominal CT to have the small intestine regionally distended in the left upper abdomen and the inferior mesenteric vein (IMV) located over the distension. UGI showed accumulated small intestine with a round margin in the left upper abdomen. Laparoscopic surgery done under a diagnosis of left paraduodenal hernia identified the hernial orifice at the left paraduodenal fossa near the Treitz ligament. Hernial content was easily reduced and the hernial orifice close in minimal laparotomy to prevent injury of the IMV running along the anterior edge of the hernia orifice. Abdominal CT and UGI were useful for diagnosing left paraduodenal hernia because of characteristic findings. Minimally invasive surgery such as laparoscopic repair is recommended in patient with left paraduodenal hernia but without severe adhesion or strangulation.

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