Imaging of paraduodenal pancreatitis:A systematic review

BACKGROUND Paraduodenal pancreatitis(PP)represents a diagnostic challenge,especially in non-referral centers,given its potential imaging overlap with pancreatic cancer.There are two main histological variants of PP,the cystic and the solid,with slightly different imaging appearances.Moreover,imaging findings in PP may change over time because of disease progression and/or as an effect of its risk factors exposition,namely alcohol intake and smoking.AIM To describe multimodality imaging findings in patients affected by PP to help clinicians in the differential diagnosis with pancreatic cancer.METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-analyses 2009 guidelines.A Literature search was performed on PubMed,Embase and Cochrane Library using(groove pancreatitis[Title/Abstract])OR(PP[Title/Abstract])as key words.A total of 593 articles were considered for inclusion.After eliminating duplicates,and title and abstract screening,53 full-text articles were assessed for eligibility.Eligibility criteria were:Original studies including 8 or more patients,fully written in English,describing imaging findings in PP,with pathological confirmation or clinical-radiological follow-up as the gold standard.Finally,14 studies were included in our systematic review.RESULTS Computed tomography(CT)findings were described in 292 patients,magnetic resonance imaging(MRI)findings in 231 and endoscopic ultrasound(EUS)findings in 115.Duodenal wall thickening was observed in 88.8%of the cases:Detection rate was 96.5%at EUS,91.0%at MRI and 84.1%at CT.Second duodenal portion increased enhancement was recognizable in 76.3%of the cases:Detection rate was 84.4%at MRI and 72.1%at CT.Cysts within the duodenal wall were detected in 82.6%of the cases:Detection rate was 94.4%at EUS,81.9%at MRI and 75.7%at CT.A solid mass in the groove region was described in 40.9%of the cases;in 78.3%of the cases,it showed patchy enhancement in the portal venous phase,and in 100%appeared iso/hyperintense during delayed phase imaging.Only 3.6%of the lesions showed restricted diffusion.The prevalence of radiological signs of chronic obstructive pancreatitis,namely main pancreatic duct dilatation,pancreatic calcifications,and pancreatic cysts,was extremely variable in the different articles.CONCLUSION PP has peculiar imaging findings.MRI is the best radiological imaging modality for diagnosing PP,but EUS is more accurate than MRI in depicting duodenal wall alterations.

Left paraduodenal hernia presenting as recurrent small bowel obstruction

Internal hemiation of the small bowel is a relatively rare cause of intestinal obstruction. Left paraduodenal hernia resulting from abnormal rotation of the midgut during embryonic development is the most common form of congenital internal hernia. We report our experience in the diagnosis and management of a young male with left paraduodenal hernia presenting as recurrent intestinal obstruction. Correct preoperative diagnosis of left paraduodenal hernia had been difficult due to non-specific clinical presentations, but the advent of modern imaging technology makes early and correct diagnosis possible, Due to the risk of obstruction and strangulation, surgical treatment is indicated; however, timely intervention increases the likelihood of a favorable outcome.

Role of total pancreatectomy in the treatment of paraduodenal pancreatitis:A case report

BACKGROUND Paraduodenal pancreatitis(PP)is a rare form of chronic pancreatitis presenting with symptoms of duodenal obstruction.Conservative treatment is often unsuccessful and pancreaticoduodenectomy is the preferred surgical approach.A mini review of the outcomes of surgical therapy for PP shows that the results of pancreaticoduodenectomy are predominantly favorable.CASE SUMMARY In our case report of PP,we describe an unusual course first presenting with the symptoms of chronic pancreatitis and a pseudocyst of the pancreatic tail.A pseudocystojejunostomy was performed and the late postoperative course was complicated with the symptoms of duodenal obstruction.At laparotomy,PP was found and the patient was treated with a total pancreatectomy.The postoperative course was uneventful and good weight gain with resolution of pain was demonstrated at follow up visits.CONCLUSION Surgery is currently the optimal treatment option for PP.It is also the best diagnostic tool in distinguishing between pancreatitis and pancreatic adenocarcinoma.

Intestinal Obstruction and Bowel Ischemia due to a Rare Left Paraduodenal Hernia: Case Report

Bowel obstruction is one of the most common problems found in outpatient departments (OPDs) and emergency rooms. The challenge for surgeons is to be suspicious and recognizing rare disease that could cause bowel obstruction, such as paraduodenal hernia, without delaying the management as the risk of complications increase. This case study presents a patient with bowel obstruction secondary to a paraduodenal hernia.

Incarceration of Meckel's diverticulum in a left paraduodenal Treitz' hernia

Meckel's diverticula incarcerated in a hernia were first described anecdotally by Littré, a French surgeon, in 1700. Meckel, a German anatomist and surgeon, explained the pathophysiology of this disease 100 years later. In addition, a congenital paraduodenal mesocolic hernia, known as a Treitz hernia, is a rare cause of small bowel obstruction. These hernias are caused by an abnormal rotation of the primitive midgut, resulting in a right or left paraduodenal hernia. We treated a patient presenting with pain and diagnosed extraluminal air in the abdomen after a computed tomography examination. We performed a laparotomy and found a combination of these two seldomly occurring congenital diseases, incarceration and perforation of Meckel's diverticulum in a left paraduodenal hernia. We performed a thorough review of the literature, and this report is the first to describe a patient with a combination of these two rare conditions. We considered the case regarding the variety of terminology as well as the treatment options of these conditions.

Left paraduodenal hernia in an adult complicated by ascending colon cancer: A case report

Paraduodenal hernia is the most common internal hernia. The clinical symptoms of paraduodenal hernia may be intermittent and nonspecific. Therefore, it is difficult to diagnose preoperatively. Abdominal computed tomography （CT） scan currently plays an important role in the evaluation and management of paraduodenal hernia before surgical operation. We report one unique case of preoperatively diagnosed left paraduodenal hernia complicated by advanced ascending colon cancer and reviews of Japanese literature.

Laparoscopic correction of hydronephrosis caused by left paraduodenal hernia in a child with cryptorchism:A case report

BACKGROUND Paraduodenal hernia(PDH)is a mesenteric-parietal hernia with retroperitoneal and retrocolic herniation of the small bowel into a sac,which is formed by a peritoneal fold located near the fourth portion of the duodenum.The present case revealed that PDH was a possible reason for hydronephrosis,and that the carful laparoscopic exploration surgery was necessary to find infrequent causes of hydronephrosis to avoid invalid Anderson–Hynes pyeloplasty surgery and its injury.CASE SUMMARY An 8-year-old boy presented to the pediatric department with a chief complaint of cryptorchidism.Afterwards,laparoscopy confirmed hydronephrosis secondary to left PDH with cryptorchid.Then,he received laparoscopic surgery,fixed operation for left PDH,release of the ureteropelvic junction obstruction,and treatment for hydronephrosis.It is necessary to perform secondary surgery for cryptorchidism and long-term follow-up.CONCLUSION The case revealed an extremely rare cause of hydronephrosis in children,suggesting a potential correlation between PDH and hydronephrosis.

Stranched Internal Hernia Revealed by Occlusion of the Large Libra: A Propos of a Case

The left para-duodenal internal hernia, whose origin is generally embryological, is a rare etiology of intestinal obstruction found mainly in young adults. We report here the case of acute intestinal obstruction by left para-duodenal internal hernia in a 36-year-old young man. It was a patient who consulted urgently for occlusive syndrome with cessation of materials and gases. Abdominal percussion noted abdominal tympanism and pre-hepatic dullness was preserved. The flow and icicle signs were negative. Palpation did not objectify hepatosplenomegaly and did not find any organomegaly either. On the other hand, she found an epigastric defense. The abdominal X-ray without preparation showed water levels that were wider than high, hail-like. We performed a median above and below umbilical laparotomy and intraoperatively, it was an internal hernia with incarceration of small loops in a voluminous left paraduodenal sac of 12 cm. They were not necrotic and quickly recolored after extrication. We resected the hernial sac and closed the hernial orifice with separate stitches with absorbable suture 0. The postoperative course was simple. The patient was discharged from the hospital on the 4th postoperative day. After 18 months of hindsight, he is doing well.

Right paraduodenal hernia:report of two cases and review of literature

Paraduodenal hernia(PDH),a rare congenital anomaly,is a type of internal hernia which occurs due to a defect in the reduction and rotation of the midgut.On anatomical and embryological basis,PDH can be broadly divided into right-and Left PDH.Right PDH is rarer than its counterpart.We present two cases of Right PDH.The patientsy presented with a history of recurrent intestinal obstruction since childhood,which was managed conservatively,without a definitive diagnosis.Once they presented to us,a detailed clinical history and a barium meal follow-through clinched the diagnosis of PDH.Intra-operative findings correlated well with the clinical diagnosis.The jejunal loops had herniated through the fossa of Waldeyer.Reduction of hernia contents and excision of the hernia sac was carried out.Post-operatively,the patients are healthy and symptom-free at 4 and 3 years follow-up,respectively.The rarity of this condition and the need for early diagnosis,to prevent the high risk of bowel obstruction and strangulation,makes PDH one of the difficult challenges for the clinicians.