Multi-slice computed tomography diagnosis of left paraduodenal hernia in an adult complicated by volvulus: a case report

作者：Li, Haifei; Wang, Xia; Tan, Keping; Yi, Gaofeng; Wang, Peiyuan^*

来源：International Journal of Clinical and Experimental Medicine, 2016, 9(11): 22428-22433.

• Internal hernias
• intestinal obstruction
• multi-slice computed tomography
• paraduodenal hernias
• volvulus

Internal hernia is an uncommon cause of intestinal obstruction, of which paraduodenal hernias are the most common. It is difficult to diagnose this entity clinically, as symptoms tend to be nonspecific; computed tomography (CT), however, is diagnostic. A case of 29-year-old female with 11 hours of progressive, severe, and sharp left sided abdominal pain was retrospectively studied. The diagnostic value of preoperative multi-slice computed tomography (MSCT) was evaluated. On MSCT, a cluster of small bowel loops to the left of the fourth portion of the duodenum, within the fossa of Landzert was demonstrated. And a reverse C-shaped significant expansion loop, filled with fluid and a small amount of air was shown on multiplanar reformation imaging (MPR). The distal afferent, proximal efferent and both sides of the C-shaped loop were concentrated to a point and showed irregular blind ends. The first jejunal arterial branch was in drumstick congestion with twisted terminal branches on MPR and CT angiography images. The CT diagnosis of left paraduodenal hernia and volvulus with obstruction was made, and confirmed by laparotomy. With regards to the patients presenting with intestinal obstruction, focus should be made on the changes around the herniation, including supplying vessels, as well as afferent and efferent loops anatomy using the multi post-processing technique, to determine the etiology of the obstruction and to plan the surgical approach.

• 出版日期2016
• 单位滨州医学院