Enteropathy T cell lymphoma is an unusual variant of intestinal lymphoma. It is associated with celiac disease and responds to gluten free diet. It has a higher rate of perforations because of circumferential ulcers. It is commonly seen in jejunum and ileum
Ref- Schakelford Surgery of Alimentary canal pg 1205
Left paraduodenal hernia is the most common internal hernia. The afferent limb is the fourth part of the duodenum and the efferent limb is the terminal ileum. The small bowel invaginates into the fossa of Landzert, which lies to the left of the fourth portion of the duodenum
In right paraduodenal hernia its Superior Mesenteric artery which forms the anterior part of the sac and not the inferior mesenteric artery.
All para duodenal hernias should be operated because of 50% risk of incarceration.
Options in Left paraduodenal hernia
1. Manual reduction of small bowel with closure of hernia orifice
2. If small bowel cannot be reduced; hernia orifice can be widened on the right side of Inferior mesenteric vein avoiding damage to inferior mesenteric vein and ascending branch of left colic artery
3. Open the sac along the anterior wall
Stoma Necrosis - 1-5%
Intestinal Obstruction upto 17%
Ileostomy diarrhea- 25%
Stomal Retraction again upto 17%
Parenteral nutrition leading to liver failure is a long term problem in patients undergoing surgery for short bowel syndrome. It can be avoided by giving as large a portion as possible by enteral method, prevent bacterial overgrowth and sepsis. Bacterial overgrowth occurs because of stasis and impaired motility or due to intestinal obstruction. Avoid giving excessive fat, and preventing and treating nutritional deficiencies
Ref Book: Shackelford's Surgery of Alimentary canal