Diagnosis and management of paraduodenal hernia

Internal hernias cause 1% of intestinal obstructions with aproximately 50% of these hernias been para-duodenal hernias. Paraduodenal hernias are the product of a malrotation of the midgut during embryogenesis or a non-fusion of the peritoneal folds. These type of internal hernia are more common in males and on the left side of the abdomen. The usual presentation age is in the 4(th) decade of life. The clinical presentation of these patients is non specific and varies, ranging from mild dyspepsia to intestinal perforation and septic shock. The radiographic studies of these patients show a clumping of the intestinal loops on the upper quadrant of the abdomen with an image of abdominal compartamentalization. The surgical management of these patients should follow three simple principles. The intestines should be reduced, their perfusion and viability must be verified and the hernia sack entrance should be repaired with interrupted non absorbable sutures.