[Etiopathogenic and clinico-therapeutic considerations on Spigelian lateral ventral hernia. A caseload and review of the literature]. / Considerazioni etiopatogenetiche e clinicoterapeutiche sull'ernia ventrale laterale di spigelio. Contributo casistico e revisione della letteratura.

The authors report on 6 cases of Spigelian hernia surgically managed over the period from 1973 to 2002. They describe the anatomy of the anterolateral abdominal wall and the etiopathogenetic factors of this rare type of hernia. The clinical features of the disease are discussed and the diagnostic usefulness of a thorough physical examination is stressed, as is the value of imaging procedures when the hernia is not evident. They, then, go on to describe the repair techniques currently available that are capable of yielding an excellent long-term outcome.

Cardiac abnormality with associated hernia in farmed rainbow trout Oncorhynchus mykiss.

A new type of cardiac malformation in rainbow trout Oncorhynchus mykiss from a broodstock fish farm is described. The ventricle of affected fish was located dorsodextrally to the atrium, while the latter was saccular, grossly enlarged and protruded through the muscles of the ventral body wall, forming a hernia covered only by dermis and epidermis. Histopathological changes included hypoplasia of the outer compact layer of the ventricular myocardium and severe distension of trabecular structures within the ventricle and atrium. Affected fish tolerated stress very poorly, and the majority of the affected fish died during the freshwater period. The causation(s) are not known, but hereditary and environmental factors are likely, as no infectious agents were isolated or detected microscopically.

Tibial hemimelia, meningocele, and abdominal hernia in Shorthorn cattle.

Six genetically related Shorthorn calves were affected with the tibial hemimelia syndrome. The lesions included bilaterally malformed or absent tibia and abdominal hernia in all animals, a long shaggy haircoat, retained testicles in males, and meningocele in three animals. The malformations were similar to those described previously in Galloway calves. Pedigree analysis demonstrated a mechanism by which a recessive allele in a homozygous state could be responsible for the disorder. The condition in these calves was considered the result of a recurrence of a genetic mutation affecting a putative hemimelia locus.

Outcome of prenatally diagnosed anterior abdominal wall defects.

One hundred consecutive cases of confirmed anterior abdominal wall defect, identified prenatally in the Oxford Prenatal Diagnosis Unit over 11 years, were studied. Fifty nine per cent of cases were suspected omphaloceles and 41% suspected gastroschisis. Fifty four per cent of omphaloceles were accompanied by other defects compared with 5% of those with gastroschisis. Overall, 29% of fetuses with omphalocele had an abnormal karyotype, and of those with another abnormality identified on scan (excluding four cases with no karyotype performed), 54% had an abnormal karyotype. Of the 27 cases with suspected isolated omphalocele, 14 were live born, all of whom have survived. If the 11 whose parents opted for termination of pregnancy are excluded, survival to birth was 88%. Six of the suspected isolated omphaloceles have Beckwith Wiedemann syndrome (BWS). Eight (57%) of the live born babies with omphaloceles had major problems up to the age of 2, but only one (7%) has long term major problems. This child has BWS and is deaf. Of the 39 cases of suspected isolated gastroschisis, 33 (85%) pregnancies resulted in live birth and one in neonatal death after surgery. Survival rate (excluding terminated pregnancies) was 97%. Gastroschisis was associated with a younger maternal age than omphalocele (p < 0.001) and lower birthweight centile (p < 0.01). Fifteen per cent of the gastroschisis babies had major problems up to the age of 2 years and 12% long term developmental problems. Ninety three per cent of the omphalocele babies and 88% of those who had gastroschisis have no long term problems. Over the study period there have been major changes in scanning equipment and expertise. Since 1991 no woman with a suspected isolated lesion has opted for termination of pregnancy.

Omphalocele and gastroschisis: a collaborative study of five Italian congenital malformation registries.

During 1984-1989, 116 cases of omphalocele and 42 cases of gastroschisis were detected among 736,760 consecutive births in the area covered by five Italian congenital malformation registries. The prevalence rate was 1.6 per 10,000 for omphalocele and 0.6 per 10,000 for gastroschisis. Three additional cases were detected among spontaneous abortions, giving a total of 117 cases of omphalocele and 44 of gastroschisis. No variations in prevalence rates were observed among registries. A cluster of omphalocele was found in 1989 in Firenze. All cases were sporadic except for one infant with two sibs with Beckwith-Wiedemann syndrome. A predominance of male infants was observed for both defects. This study confirms the very young maternal age for isolated gastroschisis as compared to that for omphalocele and controls. Birth weight and the percentage of small-for-date is different among isolated gastroschisis, omphalocele and controls. Associated anomalies occurred in 45 cases of omphalocele and 11 cases of gastroschisis. Our data confirm the association of omphalocele with trisomies 13 and 18. Twelve cases of omphalocele and gastroschisis with associated limb defects were classified as limb body wall complex. The possible differences in etiopathology between omphalocele and gastroschisis, both isolated and associated, are discussed.