絞やく性イレウス術後に発症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 DEVELOPED AFTER SURGERY FOR STRANGULATED ILEUS

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A 50-year-old woman was seen at the hospital because of right lower abdominal pain. Because she had peritoneal sign and an abdominal CT scan showed the swollen wall of the small intestine, an emergency operation was performed with a diagnosis of strangulated ileus. At surgery, a 60cm-long portion of the ileum was impacted an interspace formed by adhesions between the small bowel mesentery and retroperitoneum. Oral ingestion was started from the postoperative day 3, however, the patient had vomiting since the postoperative day 10. Upper gastrointestinal series revealed malrotation and poor defluxion of contrast material from the descending part of the duodenum to anal side. Abdominal CT scan showed cystic accumulation to the retroperitoneal cavity on the right side of the small intestine. From these findings right paraduodenal hernia was diagnosed and re-operation was performed. A 50cm-long portion of the proximal jejunum was impacted in the right paraduodenal fossa. The jejunum was manually reduced and plication suture was made for the hernia opening.<br> It is considered that the disease occurs when an acquired increase in the intraabdominal internal pressure or abnormal bowel movement is added to hernia sac formed by congenital malrotation. This case is thought to support the consideration. To the best of our knowledge there have been no other cases which followed such a clinical course as this case followed.

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