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Two acute pediatric abdominal catastrophes from strangulated left paraduodenal hernias
J Pershad1, G T Simmons, D Chung
1Division of Emergency Medicine, The Children's Hospital of Alabama, USA.
Insights
Left paraduodenal hernia (PDH) can cause sudden, fatal intestinal obstruction. Prompt surgical evaluation is crucial for this common internal hernia to prevent catastrophic outcomes and mortality.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Paraduodenal hernia (PDH) represents the most frequent type of internal hernia.
- Strangulation of a PDH carries significant risks of morbidity and mortality.
Observation:
- Two cases of catastrophic intestinal obstruction due to strangulated left PDH are presented.
- These cases highlight rapid deterioration and demise within hours of symptom onset.
Findings:
- Left PDH, though common, can lead to acute, life-threatening complications.
- Sudden death from a left PDH strangulation is a rare but possible outcome.
Implications:
- Early surgical consultation is vital for suspected PDH, even with limited emergency department evaluation.
- Consider PDH in patients with unexplained chronic, intermittent abdominal pain.
- Awareness of PDH's potential for rapid, fatal strangulation is critical for clinicians.
Abstract:
We present two cases of catastrophic intestinal obstruction from to strangulation of a left paraduodenal hernia (PDH). PDH is the most common internal hernia. Early diagnosis and treatment are essential because of the high morbidity and mortality associated with strangulation. Early involvement of the surgical team without an overly extensive evaluation in the emergency department is important if this diagnostic suspicion exists. PDH should also be considered when there is a history of chronic, intermittent abdominal pain of unclear cause. To our knowledge, these cases are the first described cases of sudden demise within a few hours of onset of symptoms of a left PDH.