Investigation of a connection between abdominal wall defects and severity of the herniation in fetuses with gastroschisis and omphalocele.

Analyze the biometric parameters and the size (area) of abdominal wall defect (AWD) in fetuses with gastroschisis and omphaloceles and correlate them with the herniated internal organs. We studied 22 fetuses (11 with AWDs and 11 without anomalies). In all fetuses we evaluated the xiphopubic distance (XPD) and iliac crest distance (ICD). In fetuses with AWDs we dissected the abdominal wall and measured the width and length of the defect for calculating its area and studying the correlation between the size of the defect with the organs that were herniated. For statistical analysis, the Anova and Tukey post-test were used (p < 0.05). The XPD in the control group had mean of 4.2 mm (2.3-5.9; SD ± 1.11), while in the AWDs it was 4.2 mm (2.9-5.5; SD ± 0.98) (p = 0.4366). The ICD had mean values of 2.5 mm (1.6-3.4; SD ± 0.58) in the control group, and 2.3 mm (1.2-3.0; SD ± 0.56) in AWDs fetuses (p = 0.6963). The number of herniate organs do not have significant correlation with the area of the defect (r2 = 0.2504, p = 0.5068). There is no correlation between the size (area) of abdominal wall defects and the number of the internal organs that herniated. Therefore, the hole size is not a predictor of the severity of the gastroschisis or omphalocele.

Hernia de Petit congénita en un escolar. Reparación con malla protésica. Reporte de caso / Congenital Petit's hernia in a Escolar. Prosthetic Mesh Repair. Case Report

Resumen Introducción: La hernia lumbar de pared abdominal congénita es una condición rara, existen alrededor de 50 casos publicados en la literatura inglesa; se clasifican según su sitio anatómico de aparición: en triángulo lumbar superior e inferior. Caso clínico: Paciente masculino, 6 años de edad, presenta masa en región lumbar izquierda, congénita, reducible, tamaño de 10 x 8 cm. El ultrasonido abdominal mostró defecto herniario compatible con hernia de Petit congénita. Se realizó reducción del saco herniario con plastía anterior y colocación de malla protésica en el defecto. Discusión: El triángulo de Grynfelt-Lesshaft es más grande y constante que el de Petit, este último representa el lugar menos común de localización. Se describen varias técnicas de reparación, pero la hernioplastía anterior es la más recomendada. Conclusiones: La hernia lumbar debe considerarse como diagnóstico diferencial en todo recién nacido que presenta masa en flanco izquierdo o derecho al nacimiento, con presencia o ausencia de otra malformación. El diagnóstico temprano evita complicaciones y permite el tratamiento oportuno, ofreciendo una mejor calidad de vida al paciente.

Introduction: The abdominal wall congenital lumbar hernia is a rare condition, There are around 50 cases describe in the English literature. These are classified according to their anatomical site of appearance, upper or lower lumbar triangle. Case presentation: A 6-year-old male patient presented congenital left mass in the lumbar region, reductible, size 10 x 8 cm; during abdominal ultrasound, hernia was compatible with Petits congenital hernia. A reduction of the hernial sack with anterior plasty and placement of the prosthetic mesh at the defect site was performed. Discussion: The triangle of Grynfelt-Lesshaft, is larger and more constant than the triangle of Petit, the latter represents the least common location. Several repair techniques are described, but anterior hernioplasty is the most recommended. Conclusion: Lumbar hernia should be considered as a differential diagnosis in all newborns with protruding mass on the left or right flank at birth, accompanied or not by another obvious or non-evident malformation. Early diagnosis avoids possible complications and allows for opportune treatment, allowing the patient a better lifestyle.

Hernia lumbar bilateral de Grynfelt Lesshaft: un nuevo reporte / Bilateral lumbar Grynfelt Lesshaft hernia: a new report

Fundamento: de las hernias lumbares, la congénita es la menos frecuente y representa menos del 20 porciento, entre las adquiridas la menos observada es la espontánea o primaria. Se expone la anatomía de la pared abdominal posterior con sus dos triángulos, inferior de Petit y superior de Grynfelt Lesshaft que dan lugar a hernias lumbares de igual nombre. La hernia lumbar superior es más frecuente que la inferior y se origina en el triángulo superior, es inusual la presencia de hernia bilateral; se actualiza la clasificación, diagnóstico y tratamiento.Objetivo: exponer lo infrecuente de la hernia Grynfelt Lesshaft, al ser bilateral y tratada por cirugía ambulatoria con anestesia local.Caso clínico: se reporta el caso de una paciente diagnosticada con hernia primaria espontánea de Grynfelt Lesshaft bilateral y tratada por cirugía ambulatoria con anestesia local.Conclusiones: debe conocerse la anatomía de esta región y aplicar el tratamiento adecuado, con las distintas variantes técnicas que permitan lograr el éxito terapéutico en esta variedad de hernia.(AU)

Background: among lumbar hernias, congenital one is the less frequent and represents less than 20 percent. From the acquired ones, the less observed is the spontaneous or primary. The anatomy of the posterior abdominal wall with its two triangles, inferior of Petit and superior of Grynfelt Lesshaft is presented. Lumbar hernias are named after them. Superior lumbar hernia is more common than the inferior and it originates in the superior triangle. The presence of bilateral hernia is unusual. Classification, diagnosis and treatment are updated.Objective: to show how infrequent is Grynfelt Lesshaft hernia since it is bilateral and treated with ambulatory surgery with local anaesthesia.Clinical case: the case of a patient diagnosed with spontaneous primary Grynfelt Lesshaft bilateral hernia is reported and treated with local anaesthesia in ambulatory surgery.Conclusions: anatomy of this region should be known and the effective treatment with different technical variants that permit to achieve therapeutic success in this type of hernia.(AU)

Giant congenital mesenteric hernia in the adult.

INTRODUCTION: Internal hernia is a visceral protrusion through a defect or aperture, either mesenteric or peritoneal and is an uncommon cause of intestinal obstruction. Within this group, the congenital mesenteric (transmesenteric) hernia is extremely rare, being more common in the pediatric population. OBJECTIVE: To present the case of a 38-year-old woman with intestinal obstruction and acute abdomen who underwent surgery. A giant mesenteric (transmesenteric) hernia was found. The hernia was reduced and the defect closed. Discharge was made without complications. CONCLUSIONS: Congenital mesenteric hernias are an infrequent pathology that may cause intestinal obstruction, predominantly in the pediatric population. Occurrence in adults is extremely rare.