術前に診断した右傍十二指腸ヘルニアの１例

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  • A CASE OF RIGHT PARADUODENAL HERNIA DIAGNOSED PREOPERATIVELY

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We present a case of right paraduodenal hernia diagnosed before surgery. A 32-year-old man was admitted to the hospital because of epigastralgia. Laboratory data showed the white blood cell count of 10, 600/μl. But other blood biochemical data were within the normal ranges including liver, muscle and renal functions. There was distention with tenderness in the upper abdomen, but no peritoneal signs were present. He had experienced the same symptoms at the age of 28 when the symptoms disappeared with hospitalization and treatment for several days. Abdominal plain roentgenogram demonstrated the right-side colon pushed out to the lower wall of liver. Enhanced computed tomography (CT) of the abdomen showed a 12-cm mass of the small intestine at medial side of the ascending colon and dorsal aspect of the transverse colon. It was thought that this mass was formed because the small intestine had penetrated through the dorsal aspect of superior mesenteric artery into the right retroperitneal space. So we diagnosed the case as right paraduodenal hernia and an emergency operation was performed. A 150-cm portion of the proximal jejunum penetrated into the right retroperitneal space through the caudal side of the ascending portion of the duodenum. Because this jejunum had no ischemic change after manual reduction, we only sutured the hernial orifice. He improved despite paresis of intestine and was discharged from the hospital on the 48th day after the operation.<br>Generally, paraduodenal hernia is difficult to diagnose before operation. In our case, we could diagnose before the operation based on subjective, and objective symptoms, X-ray and CT findings typical of this disease.

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