Rare Hernias Presenting as Acute Abdomen- A Case Series

John, Roney Johnson; Ulahannan, Sansho Elavumkal; Kurien, John S.; Joseph, Aneesh; Kurien, Annie Sandhya; Varghese, Sandeep Abraham; Thomas, Bindhya; Varghese, Fobin

doi:10.7860/jcdr/2016/17356.7401

Cited by 6 publications

(3 citation statements)

References 8 publications

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“…Spigelian hernias can present as acute small bowel obstructions [ 15 , 21 ] even of the colon [ 22 ]. Most Spigelian hernias present a localised hernia, or as local pain with or without a hernia sac [ 15 – 20 ].…”

Section: Resultsmentioning

confidence: 99%

Spigelian hernia in gynaecology

Ussia¹,

Imperato²,

Schindler

et al. 2017

Gynecol Surg

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BackgroundA Spigelian hernia is a rare hernia through the Spigelian fascia between the rectus muscle and the semilunar line. This hernia is well known in surgery. Symptoms vary from insidious to localised pain, an intermittent mass and/or a bowel obstruction.ResultsThe Spigelian hernia is poorly known in gynaecology. Spigelian hernias may be causally related to secondary trocar insertion. This review is written to increase awareness in gynaecology and is illustrated by a case report in which the diagnosis was missed for 4 years even by laparoscopy. Smaller hernias risk not to be diagnosed and will thus not be treated. Even larger Spigelian hernias might not be recognised and treated appropriately.ConclusionsThe gynaecologist should consider a Spigelian hernia in women with localised pain in the abdominal wall lateral of the rectus muscle some 5 cm below the umbilicus. Smaller hernias can be closed by laparoscopy without a mesh. Larger hernias require a mesh repair.

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Section: Resultsmentioning

confidence: 99%

Spigelian hernia in gynaecology

Ussia¹,

Imperato²,

Schindler

et al. 2017

Gynecol Surg

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“…They occur through defects in the anterior abdominal wall adjacent to the semilunar line, frequently in the lower abdomen 2. In many cases, the diagnosis of Spigelian hernia is not straightforward because the external oblique muscle overlies the defect in the deeper fascia and also symptoms can vary from abdominal pain, a lump in the anterior abdominal wall or signs of bowel obstruction 2. While incarceration or strangulation of Spiegel’s hernias can occur in up to 24% of the cases, sonography and CT scan are the most commonly used adjuncts for the diagnosis 3.…”

Section: Descriptionmentioning

confidence: 99%

Strangulated Spiegel’s hernia mimicking ischaemic colitis: endoscopic diagnosis of a rare surgical emergency

Gonçalves¹,

Monteiro

Marinho

et al. 2018

BMJ Case Reports

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DesCripTionAn 84-year-old man was referred to the emergency department with a 2-day history of colicky abdominal pain in the left lower quadrant, bloody diarrhoea and abdominal distension. Nausea and two episodes of watery vomiting were reported as well. Past medical history was remarkable for arterial hypertension, dyslipidaemia and ischaemic stroke, for which he was taking lisinopril, hydrochlorothiazide, simvastatin and acetylsalicylic acid. Surgical background included laparotomy for appendectomy and appendicular abscess drainage 8 years before.Physical examination showed stable vital signs and a distended abdomen, with tenderness in the left lower abdominal quadrant, but no signs of peritoneal irritation. An obvious, but reducible, abdominal wall hernia was palpable in the same location. The remaining exam was unremarkable.Laboratory results revealed mild anaemia (haemoglobin-12.7 g/dL) and leukocytosis (white cell count-11.7×10 9 /L), acute kidney injury (creatinine-2.1 mg/dL) and elevated C reactive protein (298 mg/L). Liver function tests, electrolyte panel, amylase and lactate dehydrogenase were within the normal range.An abdominal CT scan showed thickening of the descending colon wall and a left-side Spiegel's hernia with epiploic fat and a segment of the descending colon protruding through the hernia orifice (figure 1). However, as the patient had a reducible hernia at physical examination, he was admitted to the ward with the suspicion of ischaemic colitis and put under bowel rest, intravenous hydration and antibiotic therapy with metronidazole and ciprofloxacin.A flexible sigmoidoscopy was performed 48 hours after admission for confirmation of the suspected diagnosis of ischaemic colitis. Endoscopic evaluation revealed an abrupt transition from normal colonic mucosa to a markedly oedematous, violaceous, fibrin-covered mucosa within an area of decreased luminal calibre (figure 2). Abdominal transillumination was noted in the left lower abdominal quadrant at the limit of scope's progression, and a diagnosis of incarcerated Spiegel's hernia was confirmed.The patient was submitted to an urgent laparotomy, in which an extensive segment of colonic necrosis (from splenic flexure to proximal sigmoid colon) without perforation was identified. After segmental colectomy of the unviable colon, an end colostomy was performed. The patient recovered uneventfully and was discharged 10 days after surgery.Spiegel's hernias are very uncommon and are estimated to account for 0.12% of all abdominal wall hernias.1 They occur through defects in the anterior abdominal wall adjacent to the semilunar line, frequently in the lower abdomen.2 In many cases, the diagnosis of Spigelian hernia is not straightforward because the external oblique muscle overlies the defect in the deeper fascia and also symptoms can vary from abdominal pain, a lump in the anterior abdominal wall or signs of bowel obstruction.

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“…Computed tomography (CT) is the gold standard for diagnosis for PDH [12] but only correctly identifies pathology in 43% of cases [13]. PDH will appear on CT as a cluster of dilated bowel segments, variably with an intestinal closed loop and associated engorged and displaced mesenteric vessels around the hernia orifice and sac [14]. Understanding the anatomy associated with left and right PDH is paramount.…”

Section: Introductionmentioning

confidence: 99%

Identification and Repair of Left-Sided Paraduodenal Hernia Using Both Laparoscopic and Robotic Techniques

John¹,

Hsu²,

Matthew³

et al. 2020

Case Reports in Surgery

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Internal hernias are an uncommon cause of small bowel obstruction and present a challenging clinical diagnostic scenario. They result from the abnormal protrusion of an abdominal organ through a peritoneal defect and can cause intermittent obstructive symptoms, diffuse abdominal discomfort, and postprandial pain. Paraduodenal hernias comprise 53% of all internal hernias 1 and occur due to failure of the fixation of either the left or transverse mesocolon to the posterior abdominal wall. Its relative rarity results in mortality between 20 and 50% 2 because of delayed diagnosis and consequent obstruction, strangulation, and bowel ischemia. Our case series describes three patients before and after operative fixation of paraduodenal hernia. Only one of the three was identified by preoperative radiologist interpretation. Subsequent diagnosis and definitive treatment were completed by surgical staff to resolve undiagnosed undulating abdominal pain and obstructive-type symptoms. We further analyze left-sided paraduodenal hernias after laparoscopic and robotic repair to define common symptomatology, typical CT findings, and preferred laparoscopic repair techniques.

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Rare Hernias Presenting as Acute Abdomen- A Case Series

Cited by 6 publications

References 8 publications

Spigelian hernia in gynaecology

Spigelian hernia in gynaecology

Strangulated Spiegel’s hernia mimicking ischaemic colitis: endoscopic diagnosis of a rare surgical emergency

Identification and Repair of Left-Sided Paraduodenal Hernia Using Both Laparoscopic and Robotic Techniques

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