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Abstract: A 49-year-old Mr. Wang came to the hospital with recurrent episodes of peri-umbilical pain with no obvious cause. Combining the findings of physical examination and imaging, Mr. Wang was diagnosed with a right paraduodenal hernia and underwent laparoscopic repair of a right paraduodenal hernia, after which Mr. Wang’s peri-umbilical pain disappeared and he gradually resumed normal diet, and his condition gradually improved.
Basic information】Male, 49 years old
Disease Type】Right paraduodenal hernia
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】June 2022
Treatment plan】Surgical treatment (right paraduodenal hernia repair under laparoscopy) + medication (sodium chloride glucose injection, ceftazidime for injection, cefuroxime sodium for injection)
[Treatment period] 1 week of hospitalization, 1 month of follow-up
Effectiveness】The pain around the umbilicus disappeared, normal diet gradually resumed, and the condition gradually improved.
I. Initial consultation
Mr. Wang came to the outpatient clinic and reported that he had periumbilical pain without any cause six months ago, with no other discomfort, and his symptoms were relieved after examination and medication at the communal hospital. Mr. Wang’s initial examination was carried out, physical examination: skin color was normal, skin temperature was not high, abdomen was mildly distended, no abdominal wall varices and gastrointestinal type and peristaltic waves were seen, periumbilical pain on pressure, no rebound pain and muscle tension, no enlargement under the ribs of liver and spleen were palpated, intestinal sounds were possible, no mobile turbid sounds on percussion, no gas-over-water sounds and metallic sounds were heard, no abdominal ultrasound abnormalities were seen, abdominal CT examination was performed, the results showed that: right The abdominal ultrasound did not show any abnormality. Mr. Wang was in good health, with no history of underlying diseases, no family history, and no history of drug allergy, and was initially considered to be a right duodenal hernia.
(CT examination was performed, and the results showed: abnormal dilatation of jejunal collaterals in the right side of the hypochondrium, and flat gas and fluid)
II. Treatment history
After admission, Mr. Wang further improved chest X-ray, electrocardiogram, three major routine tests, liver and kidney function, coagulation function, infectious diseases and other related tests, and no significant abnormalities were found. A standing abdominal plain film showed dilated intestinal canal; an enhanced abdominal CT was performed, which showed a displacement of the small intestine and the formation of a soft tissue mass in the right upper abdominal cavity, and a right paraduodenal hernia was considered.
Subsequently, total gastrointestinal imaging was performed, and the results showed that the passage of barium through the small intestine was delayed, and the mass-like small intestinal loops were gathered on the right side of the abdomen, which was considered as a right paraduodenal hernia (right type), and combined with the results of Mr. Wang’s physical examination and imaging examination, it was clear that Mr. Wang had a right paraduodenal hernia. Once the diagnosis was confirmed, we immediately communicated with Mr. Wang and arranged to perform right paraduodenal hernia repair under laparoscopic anesthesia.
After the operation, Mr. Wang returned to the ward with a good dressing and no redness, swelling and exudation. After the operation, he was given sodium chloride injection with glucose to maintain the water-electrolyte and acid-base balance, ceftazidime for injection and cefuroxime sodium for injection to prevent E. coli and mixed bacterial infections, and daily clean drug changes.
III. Treatment effect
After the operation, Mr. Wang recovered well, and no infection occurred at the surgical puncture site. The pain around the umbilicus disappeared, and he gradually resumed normal diet and gradually improved. After 1 week of hospitalization, Mr. Wang had the wish to be discharged from the hospital, and after examination, his vital signs were stable and his wound was recovering well, so he was discharged from the hospital, and was asked to follow up after 1 month.
One month later, Mr. Wang came to the follow-up clinic, and was seen to have a rosy complexion, good spirit, no abdominal pain, normal diet, normal urination and defecation, and no abnormality in the upper gastrointestinal tract angiography.
IV. Notes
I am very pleased with Mr. Wang’s recovery, but I would like to remind Mr. Wang to pay attention to the following points in his daily life.
1, review after discharge, if the pain around the umbilicus recurs, you should be promptly hospitalized, pay attention to keep warm in life, prevent colds, if there is fever, testicular swelling and pain and other symptoms must be taken seriously, to immediately seek medical attention.
2.After discharge, avoid spicy and irritating food, indigestible food, should be light diet, can gradually transition to normal diet, keep daily bowel movement smooth, try to avoid long squatting and forceful bowel movement to avoid recurrence.
3, gradually increase the amount of activity, quit smoking and limit alcohol, avoid strenuous exercise within six months, maintain a relaxed mood, regular rest and avoid overwork.
4, timely correction of constipation, chronic cough, sneezing and other behaviors that increase intra-abdominal pressure, especially not to carry out strenuous activities, lifting heavy objects, etc.
V. Personal insight
Paraduodenal hernia is one of the types of hernia disease. Hernia surgery is one of the treatment options for hernia, but it is not the only treatment option. Although the scar left by minimally invasive hernia surgery is relatively small, the surgery will definitely cause local tissue damage and generally early hernia can be treated conservatively.
The main character of this article, Mr. Wang, came to the hospital with recurrent episodes of peri-umbilical pain without any obvious cause, and was diagnosed with a right paraduodenal hernia, which eventually improved after surgery with medication. Such patients must pay attention to keeping warm and not catching a cold, and also relax and not be nervous. If abnormalities occur, they should seek timely medical consultation, undergo regular review and receive relevant treatment according to the doctor’s diagnosis.