Abstract
IntroductionAbdominal ventral hernias are common in chronic liver disease due to increased abdominal pressure and sarcopenia. Following liver transplantation, diagnosis of chronic abdominal pain is challenging because it may relate to immunosuppression, scaring or opportunistic infections. Presentation of caseA 62 years-old male presented with chronic abdominal pain one year following liver transplantation due to hepatocellular carcinoma. After work-up he was diagnosed with a Spigelian hernia containing the appendix. We did hernia repair with mesh but appendectomy was not performed since it showed no signs of inflammation. On follow-up the patient had complete resolution of the pain. DiscussionThis is the first case of spigelian hernia containing the appendix following liver transplantation. Mesh repair can be safely performed in this setting but incidental appendectomy is controversial due to higher morbidity and mortality. In this case report we discuss the relationship between liver transplantation, abdominal hernias and the pitfalls of incidental appendectomy. ConclusionUncommon ventral hernias are a possible cause for chronic abdominal pain after surgery and should be investigated with imaging studies. Mesh repair is safe but incidental appendectomy in the immunosuppressed is not encouraged due to increased morbidity.
Highlights
Abdominal ventral hernias are common in chronic liver disease due to increased abdominal pressure and sarcopenia
Up to 43% of the recipients develop incisional hernias [2] and emergence surgery is associated with higher morbidity and mortality [3,4]
Diagnosis is challenging since symptoms can be subtle and chronic abdominal pain may relate to adhesions, immunosuppression or opportunistic infections
Summary
Abdominal ventral hernias are common in chronic liver disease due to increased abdominal pressure and sarcopenia. Diagnosis of chronic abdominal pain is challenging because it may relate to immunosuppression, scaring or opportunistic infections. PRESENTATION OF CASE: A 62 years-old male presented with chronic abdominal pain one year following liver transplantation due to hepatocellular carcinoma. DISCUSSION: This is the first case of spigelian hernia containing the appendix following liver transplantation. Mesh repair can be safely performed in this setting but incidental appendectomy is controversial due to higher morbidity and mortality. In this case report we discuss the relationship between liver transplantation, abdominal hernias and the pitfalls of incidental appendectomy. Mesh repair is safe but incidental appendectomy in the immunosuppressed is not encouraged due to increased morbidity
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