History:
History 12 year old boy Recurrent pain abdomen – 4 years Intermittent vomitting Worked up for pain abdomen & Koch’s No conclusive diagnosis
Examination:
Examination O/E: No pallor, icterus, lymphadenopathy P/A: Soft, non tender, no VGP. Blood investigation- Normal
Investigation :
Investigation Computed tomography revealed that the small bowel was on the right side of the abdomen and the colon on the left, suspicious for malrotation Upper gastrointestinal series with small bowel follow-through revealed the DJ flexure on the right with the small bowel on the right side .
Surgery:
Surgery Initial access was obtained with a 5-mm infraumbilical port followed by placement of 5-mm ports in the right and left, lower and upper quadrants. The duodenum was identified and the bands running over it were lysed . The hernia sac was opened laterally to avoid injury to the superior mesenteric vessels. The small bowel was then released from the sac into the peritoneal cavity. The entire bowel was inspected and no other abnormalities were noted.
Laparoscopy:
Laparoscopy
Post Op:
Post Op Recovered well NG tube removed on 2 th post op day Feeds started on 3 rd post op day Discharged on 5 th post op day.
Follow up:
Follow up
Literature review Surg Endosc (2004) 18: 165–166 Springer-Verlag New York Inc. 2003:
Literature review Surg Endosc (2004) 18: 165–166 Springer- Verlag New York Inc. 2003 Paraduodenal hernia, a rare cause of small bowel obstruction, can present a diagnostic challenge. However, when the diagnosis is made preoperatively, a laparoscopic repair is a feasible and practical option .
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