Levatorhernie durch ein parasitäres retroperitoneales Leiomyom 25 Jahre nach Hysterektomie

Abstract

Purpose: Pelvic floor hernias are rare (0.09% of all hernias), and consist of obturator, perineal and sciatic hernias in order of decreasing frequency. Case Report: The case of a 79-year-old female with a paravaginal hernia of the perineum measuring about 20 cm and covered with skin is reported. A repositioning of this herniation was possible for two years. Because of problems with self-repositioning, the patient presented at our institution. The patient's history had been uneventful despite an abdominal hysterectomy with bilateral adnexectomy 25 years ago. Ultrasound revealed a hernial sac with a non-echogenic, homogenous and well vascularized content. Computer tomography confirmed those findings. After disclosure of the hernial sac a retroperitoneal fibroid (1350 g, 30 x 20 x 4.5 cm) was found and completely removed surgically. The hernial canal through the M. levator ani was closed by an abdominal and a perineal approach. The hernial sac was resected completely. Postoperatively the patient recovered quickly and without complications. Discussion: The presented case report describes the rare coincidence of a heavy retroperitoneal tumor causing a symptomatic perineal hernia. Abdominal or perineal operations are risk factors in the development of most pelvic floor hernias. Nevertheless, one can hardly imagine that a hysterectomy 25 years ago would have a major impact on the development of the hernia. Apart from the weight of the fibroid, the age of our patient and therefore the increased weakness of her pelvic floor muscles contributed to the development of the perineal hernia. Combined operations - abdominal and perineal - planned interdisciplinarily are the therapeutic approach for pelvic floor hernias.