In the Surgical Service of Grady hospital, two cases of duodenal hernia were observed within a period of three months. According to Moynihan classification, one of it was present at the right side, whereas the other was present at the left side. Both cases were observed clearly to find the symptoms. The first case was diagnosed correctly only by facing a fatal termination. In the second case, it was easily diagnosed by using exploratory laparotomy.
The duodenal hernia first description was found by the Klob in 1861 that is available in literature. He got a case that has a hernia at the right side. In year 1857, he depicted the possibility of the duodenal hernia that was formed in the different folds.
In 1906, Moynihan has presented the detailed report of the cases of duodenal hernia. In the report, the hernia was explained clearly. The embryologic and anatomic interpretations of both the cases have been confirmed by using Moynihan observations that were carefully studied in both cases.
The intestinal canal was represented in its fourth week of intra uterine life. The two elongated tube was connected all through the length by perotoncum tube. The dorsal bulge formed that result in building stomach and the primitive mesenteric got connected with it. The abdominal wall has a peritoneum coming out.
During the sixth week, the special arteries have provided the three segments that were noticed. These segments help in developing the duodenum and stomach, whereas the celiac axis is present in the mesentery. This portion was then presenting at the behind of the stomach that was developed by the stomach posterior wall. In the stomach, the pylorus convex junction has the pancreas head lied on it.
In the umbilicus, second segments come out from the duodeno-jenunal. The two parallel limbs that are narrow and long involving the mysentric artery are present at the back of the abdominal wall. These segments that result in the formation of the carceum, ileum, jejunum, transverse colon and ascending.Next comes the third segment that starts its formation at the splenic flexure involving the rectum, sigmoid and descending colon. It has a narrow and short mesentery that are present in the inferiod mesenteric artery.
According to Moynian description of the duodenal hernia, the duodenal jejunal is classified int onine fossae. However, only two of them have only given teh detailed description.
The duodenal hernia is rare in the remaining fossae, but in case of duodenal hernia, a proportional frequency has resulted having a fossae that could be due to the following reason.
1) In the case of duodenal hernia, superior duodenal fossae are present at the left of the duodenum ascending portion.
2) In 80 % of duodenal hernia cases, inferior duodenal fossa are present in between the third and fourth vertebra by lying at the left ascending portion.
3) At the ascending limb of duodenum, posterior duodenal fossa are present behind the upper part.
4) At the base of transverse mesocolon, duodenal jejunal fossa is present.
5) The inter-mesocolic fossa is present at the transverse mesocolon base.