Spigelian hernia.

INTRODUCTION: Spigelian hernia is a rare type of abdominal wall hernias which are often diagnosed when incarcerated. These hernias typically develop at the crossing point of the arcuate line and lateral portion of rectus abdominis muscle. CASE REPORT: We present the case of a 44-year-old female patient admitted to our surgery unit for a painful lump in her right mesogastrium. Incarcerated atypical hernia in the right mesogastrium was suspected based on completed imaging assessments. Spigelian hernia was confirmed by preoperative findings. Interestingly, the patient applied interferon (multiple sclerosis therapy) at the site of the lump, which is why the diagnosis of lipodystrophy had been considered. CONCLUSION: In general, the diagnosis of Spigelian hernia is difficult. From the anatomical point of view the clinical finding is not always specific. The risk of incarceration is relatively high, and thus even clinically silent findings are indicated for surgery.

Diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias: a retrospective study.

INTRODUCTION: To explore the diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias (IAHs), and to analyze the potential causes for missed diagnosis and misdiagnosis of IAHs in children. METHODS: A retrospective analysis was conducted on 45 children with surgically confirmed IAHs. The diagnostic rate of IAHs by preoperative high-resolution ultrasound combined with MSCT was compared with that of intraoperative examination, and the potential causes for missed diagnosis and misdiagnosis by the combination method were analyzed. RESULTS: Forty-five cases of pediatric IAHs were categorized into primary (25/45, 55.5%) and acquired secondary hernias (20/45, 44.5%). Among children with primary hernias, mesenteric defects were identified as the predominant subtype (40%). Acquired secondary hernias typically resulted from abnormal openings in the abdominal wall or band adhesions due to trauma, surgery, or inflammation. In particular, adhesive band hernias were the major type in children with acquired secondary hernias (40%). The diagnostic rate of high-resolution ultrasound was 77.8%, with "cross sign" as a characteristic ultrasonic feature. Among 10 cases of missed diagnosis or misdiagnosis, 5 were finally diagnosed as IAHs by multi-slice computer tomography (MSCT). Overall, the diagnostic rate of pediatric IAHs by preoperative ultrasound combined with radiological imaging reached 88.9%. DISCUSSION: IAHs in children, particularly mesenteric defects, are prone to strangulated intestinal obstruction and necrosis. High-resolution ultrasound combined with MSCT greatly enhances the diagnostic accuracy of pediatric IAHs.

Traumatic abdominal wall hernia in childhood: a bicycle handlebar injury.

A female patient in her middle childhood presented to the paediatric emergency room (ER) after a bicycle accident with an abdominal impact on the bicycle handlebar. On physical examination, a painful ecchymosis on the upper left quadrant was the only abnormal finding. Abdominal ultrasound showed no intra-abdominal lesions, and the patient was discharged home after 24 hours under monitoring. Nine days after the accident, she returned to the ER due to the emergence of an abdominal mass around the area of impact. Abdominal examination detected a tender non-fluctuating mass on the epigastric and left hypochondrium, and abdominal ultrasound revealed a muscle and aponeurosis disruption of the rectus muscle, with fat herniation and cytosteatonecrosis. A conservative approach was chosen, with ambulatory follow-up. One month after the accident, the patient was asymptomatic, no abdominal mass was palpable, and an abdominal CT showed a reduction of the muscle disruption and hernial content.

Comparison between the mesenteric fixation method (MEFIX) and conventional methods at preventing the occurrence of Petersen's hernia: a study protocol for a multicenter randomized controlled trial.

BACKGROUND: Petersen's hernia, which occurs after Billroth-II (B-II) or Roux-en-Y (REY) anastomosis, can be reduced by defect closure. This study aims to compare the incidence of bowel obstruction above Clavien-Dindo classification grade III due to Petersen's hernia between the mesenteric fixation method and the conventional methods after laparoscopic or robotic gastrectomy. METHODS: This study was designed as prospective, single-blind, non-inferiority randomized controlled multicenter trial in Korea. Patients with histologically diagnosed gastric cancer of clinical stages I, II, or III who underwent B-II or REY anastomosis after laparoscopic or robotic gastrectomy are enrolled in this study. Participants who meet the inclusion criteria are randomly assigned to two groups: a CLOSURE group that underwent conventional Petersen's defect closure method and a MEFIX group that underwent the mesenteric fixation method. The primary endpoint is the number of patients who underwent surgery for bowel obstruction caused by Petersen's hernia within 3 years after laparoscopic or robotic gastrectomy. DISCUSSION: This trial is expected to provide high-level evidence showing that the MEFIX method can quickly and easily close Petersen's defect without increased postoperative complications compared to the conventional method. TRIAL REGISTRATION: ClinicalTrials.gov NCT05105360. Registered on November 3, 2021.

Right paraduodenal hernia, classification, and selection of surgical methods: a case report and review of the literature.

BACKGROUND: Considering that right paraduodenal hernia is a rare internal hernia with abnormal anatomy and is often encountered during an emergency, surgeons may lack knowledge about it and choose incorrect treatment. Thus, this case report is a helpful complement to the few previously reported cases of right paraduodenal hernia. Additionally, we reviewed all the reported right paraduodenal hernia cases and proposed appropriate surgical strategies according to different anatomical features. CASE PRESENTATION: The case involved a 33-year-old Chinese male patient who was admitted to the hospital due to abdominal pain. The patient was initially diagnosed with small bowel obstruction, and conservative treatment failed. An emergency operation was arranged, during which a diagnosis of right paraduodenal hernia was made instead. After surgery, the patient recovered well without abdominal pain for 2 years. CONCLUSION: Although right paraduodenal hernia accounts only for a small proportion of paraduodenal hernia, its anatomical characteristics can vary considerably. We divided right paraduodenal hernia into three types, with each type requiring a different surgical strategy.

Internal hernia through the foramen of Winslow: a rare cause of intestinal obstruction with imminent ischaemia of the caecum.

An internal hernia through the foramen of Winslow represents a rare surgical pathology. This report describes a case with incipient caecal ischaemia and discusses current diagnostic and therapeutic approaches. A patient in his early 60s presented at the emergency department with abdominal pain and last bowel movement three days prior. A CT scan of the abdomen suggested an internal hernia into the lesser sac. Intraoperatively, the suspected diagnosis could be confirmed laparoscopically with a twisted mobile caecum herniating through the foramen of Winslow. Due to a suspected ischaemia and laparoscopic frustrated reduction, a right open hemicolectomy was performed. The hernia gap was closed. The postoperative course was uneventful. Despite the rarity of internal hernias in patients without prior abdominal surgery, surgeons should be aware of this entity. The diagnosis can be difficult and sometimes only established intraoperatively. Open surgery is usually required. If the gap is clearly identified, the recommendations tend towards its closure.

Untangling diagnostic confusion in internal abdominal hernias.

BACKGROUND: Internal hernias involve the herniation of intestines through mesenteric or peritoneal defects in the gastrointestinal system. Etiologically, they are generally classified as congenital or acquired. Internal hernias often present with non-specific symptoms. Despite the increased use of computed tomography (CT), discrepancies between imaging findings and diagnostic accuracy continue to pose challenges for clinicians. This study aims to compare the outcomes of patients presenting to the emergency department with abdominal pain and receiving a preliminary internal hernia diagnosis through CT, followed by laparotomy. METHODS: Our research is a retrospective, observational, and descriptive study. It includes patients presenting to the emergency department with abdominal pain, who were provisionally diagnosed with internal hernia based on CT. Patient data recorded age, gen-der, CT-identified internal hernia type, surgery, diagnoses, hospitalization status, duration of hospital stay, bowel resection, mortality, and blood parameters. The Welch classification was used to categorize internal hernia types, with eight types examined. RESULTS: Among 112 patients with a preliminary internal hernia diagnosis based on abdominal CT, the median age was 52 years. Of these, 46 were female and 66 were male. Among all patients, 87 were admitted to the hospital for observation and surgery, while 25 were discharged after emergency department. Paraduodenal hernias were the most common provisional diagnosis (48 cases). Among these patients, 45 were discharged after symptom relief and were advised for elective re-evaluation. The exact diagnosis for these pa-tients remains unknown. Post-surgery, the diagnosis of internal hernia was confirmed in 32 cases. Among them, 15 were female and 17 were male, with a median age of 52. The median hospital stay for patients diagnosed with internal hernia was 5 days. Although acquired hernias exhibited higher resection and mortality rates, no statistically significant difference was found. Thirty-five cases received dif-ferent diagnoses: 19 had brid ileus, five had volvulus, six had acute appendicitis, one had duodenal perforation, three had gynecological malignancies, and one had renal malignancy. CONCLUSION: Although internal hernias are rare, early diagnosis and treatment are very important due to the high risk of death. The study findings indicate that increased CT utilization leads to earlier diagnosis and treatment, resulting in improved prognosis for patients. This study holds one of the largest case series in the literature. It provides a novel perspective by evaluating radiologically-diagnosed cases, confirming diagnoses post-surgery, and comparing conditions that mimic internal hernias, thereby making a valuable contribution to the literature.

Abdominal hernia as a rare manifestation of feline mammary gland carcinoma: a case report.

A 15-year-old, spayed female, Scottish Straight cat without any traumatic history was presented with swollen abdomen and diagnosed as an abdominal wall hernia. Abdominal ultrasound revealed thickened, irregular, and hypoechoic change of abdominal wall muscle adjacent to defect. During the herniorrhaphy, multiple nodules were identified in the subcutaneous tissue around the defect. Histological examination of the nodular tissue was performed, and it was confirmed as mammary gland tumor. After the surgery, metastatic changes of the pancreas were identified, and pleural effusion and ascites were also confirmed. The patient deteriorated rapidly and died 78 days after the surgery. This is the first case presenting abdominal wall hernia induced by malignant tumor in veterinary medicine.

Monoradiculopathy-induced abdominal pseudohernia caused by T11-12 soft disc herniation: a case report and literature review.

BACKGROUND: An abdominal pseudohernia is a rare clinical entity that consists of an abnormal bulging of the abdominal wall that can resemble a true hernia but does not have an associated underlying fascial or muscle defect. Abdominal pseudohernia is believed to result from denervation of the abdominal muscles in cases of herpes zoster infection, diabetes mellitus, lower thoracic or upper lumbar disc herniation, surgical injuries, and rib fracture. To date, nine cases of abdominal pseudohernia caused by disc herniation at the lower thoracic or upper lumbar levels have been reported. CASE PRESENTATION: A 35-year-old man with no underlying disease or traumatic event presented with chief complaints of left flank pain and a protruding left lower abdominal mass that had formed one day earlier. There was no true abdominal hernia on abdominal computed tomography (CT), although CT and magnetic resonance imaging (MRI) showed a herniated soft (non-calcified) disc into the left neural foramen at the T11-12 level. A nonsteroidal anti-inflammatory drug was prescribed for the flank pain, and the patient was followed on a regular basis for six months. Follow-up MRI taken at the last visit showed complete resorption of the herniated disc. Abdominal pseudohernia and flank pain were also completely resolved. CONCLUSION: We report a rare case of monoradiculopathy-induced abdominal pseudohernia caused by foraminal soft disc herniation at the T11-12 level. In patients who have an abdominal pseudohernia without herpes zoster infection, diabetes mellitus, or traumatic events, lower thoracic disc herniations should be included in differential diagnosis.

Internal hernia caused by a congenital peritoneal defect in the vesicouterine space.

Internal hernias are protrusions of viscera that can cause obstructions such as small bowel obstruction (SBO). Diagnosis can be challenging, as they usually come with an atypical presentation. We report on a case of a woman in her early 40s, with no history of surgery or chronic illnesses, which came with abdominal pain associated with vomiting. CT scan revealed obstructed small bowel. On exploratory laparoscopy, an internal hernia through a peritoneal defect in the vesicouterine space was found, entrapping a limb of the jejunum. The entrapped loop of the small bowel was freed, the ischaemic part was resected, and the defect was closed. Our case presents the second reported case of a congenital vesicouterine defect causing SBO. It is important to consider patients presenting with SBO as a case of congenital peritoneal defect if they had no previous surgeries.

Retrocecal hernia with small bowel obstruction: a review of literature.

Retrocecal hernia, a type of internal hernia, is a rare cause of small bowel obstruction. It can come as a surprise to the operating surgeon if not diagnosed preoperatively. We hereby report a case of retrocecal hernia presenting with small bowel obstruction. A man in his early 60s presented to the emergency department with recurrent episodes of vomiting associated with abdominal pain for 3 days and the inability to pass flatus for 1 day. Preoperative imaging revealed multiple air-fluid levels with a transition point in the terminal ileum suggestive of small bowel obstruction. After adequate resuscitation, emergency laparotomy was performed, and intraoperatively, herniated ileal loop through a retrocecal defect was identified as a cause of obstruction. Herniated ileal loop was reduced, followed by the closure of the defect and cecopexy. The postoperative course was uneventful, and the patient was discharged in a stable condition. He was asymptomatic on follow-up.

Acute abdomen due to strangulated intravesical hernia with incidental finding of kidney tumor: A case report and literature review.

Internal supravesical hernia is a rare type of internal abdominal hernia with overall incidence <4% of all internal abdominal hernias. The clinical diagnosis is a major preoperative diagnostic challenge for both the surgeon and the radiologist. It is a rare cause of small bowel obstruction, but in case of strangulation it can be fatal and it necessitates urgent surgical intervention. In this case study, we report a case of intravesical type of supravesical hernia in a 63-year-old man with acute intestinal obstruction and an accidental finding of a kid-ney tumor. In the article, we discuss the clinical picture, diagnosis, risk factors, treatment strategy and complications of this rare entity.

Internal hernia caused by bridge formation between the medial and lateral segments of the liver: a case report.

BACKGROUND: Despite numerous reports on ischemic bowel obstruction caused by internal hernia, no case presentation has been reported of an internal hernia caused by a bridge formed between the medial and lateral zones of the liver. Herein, we report the first case of ischemic bowel obstruction caused by a hepatic bridge. CASE PRESENTATION: A 24-year-old man complaining of abdominal pain was referred to our hospital and admitted. Computed tomography showed formation of a closed loop of small bowel with a hernia orifice near the hilar region, and poor contrast of the prolapsed small bowel. We suspected ischemic bowel obstruction caused by an internal hernia with a fissure of the greater omentum as the hernia orifice, and performed emergency surgery. Laparoscopic observation revealed that the medial and lateral segments of the liver formed a bridge on the dorsal side at the liver portal, and that the small intestine was ischemic in the gap created between the bridge and the medial and lateral liver segments. A Meckel's diverticulum was also invaginated in the gap. The bridge was dissected out and the hernia orifice was opened to release the bowel obstruction. The small bowel was preserved and the Meckel's diverticulum was resected. The patient's postoperative course was uneventful. CONCLUSIONS: We experienced a case of ischemic bowel obstruction caused by hepatic bridge formation, which was successfully treated by laparoscopic surgery.

Conversion From Open to Laparoscopic Surgery in Strangulated Hernia Repair: Toward a Gold Option Proposal.

INTRODUCTION: Strangulation is a common presentation of acute abdominal wall hernias that usually requires emergency surgery. The aim of this report is to propose a "reverse strategy" combining an open mesh-based anterior approach followed by a "conversion" to laparoscopy for the treatment of strangulated hernias. MATERIALS AND METHODS: A 68-year-old male patient came to the emergency room of our university hospital with a non-reducible left groin hernia. The CT scan demonstrated a left groin strangulated hernia with doubtful viability of the involved bowel loop. We decided to perform a transversal inguinotomy followed by a laparoscopic approach through the inguinal ring. RESULTS: The patient was discharged after four days in perfect general condition, with normal bowel function and no postoperative pain. CONCLUSION: We propose this unconventional conversion from open to laparoscopic surgery as a new indication for the laparoscopic approach in emergency hernia surgery. We hope it can be used as a gold option for the surgical treatment of strangulated hernia in selected cases.