Ann Surg Treat Res.  2015 Nov;89(5):275-277. 10.4174/astr.2015.89.5.275.

Left paraduodenal hernia accompanying chylous ascites

• Yu DY
• Jang YJ
• Mok YJ

• KMID: 2095534
• DOI: http://doi.org/10.4174/astr.2015.89.5.275

Abstract

Paraduodenal hernia is by far the most common form of congenital internal hernia. Chylous ascites is an accumulation of lymphatic fluid in the peritoneal cavity. It develops when the lymphatic system is disrupted due to traumatic injury or obstruction. A 40-year-old, woman showed up to the Emergency Department with severe, colicky abdominal pain. Tenderness and rebound tenderness were observed at the left abdomen. Abdominal CT confirmed a cluster of dilated proximal small bowel loops with ischemic change, without ascites. The patient underwent an emergency surgery to relieve bowel ischemia. As soon as the peritoneum was exposed, 1.5 L of chylous fluid was found. A hernial sac was found along the posterior side of the mesentery of the inferior mesenteric artery. We resected the hernial sac and pulled out the herniated small bowel. On the sixth day after the surgery, she was discharged without any complication.

Keyword

Internal hernia; Chylous ascites

MeSH Terms

Abdomen
Abdominal Pain
Adult
Ascites
Chylous Ascites*
Emergencies
Emergency Service, Hospital
Female
Hernia*
Humans
Ischemia
Lymphatic System
Mesenteric Artery, Inferior
Mesentery
Peritoneal Cavity
Peritoneum
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 (A, B) The patient's abdomen CT-scan. There seems a hernial sac wrapping small bowel and hernia root is observed. There is mild ischemic change on herniated small bowel in comparison with the other segment of small bowel.

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  Fig. 2 Intraoperative photographs. (A) A hernial sac was found along the posterior side of the mesentery of the inferior mesenteric artery with large amount chylous fluid. (B) The herniated small bowel mesentery had a whitish discoloration caused by lymphatic leakage.

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