PFANNENSTIEL HERNIA – AN UNDER DIAGNOSED PATHOLOGY OFTEN OVERLOOKED AND POTENTIALLY PREVENTABLE

Abstract

Abstract Objective Pfannenstiel incision was described in 1900 and is widely used for C-section. Obstetricians tear the rectus muscles and posterior sheath apart and don’t reapproximate this layer. As consequence, it leaves a gap between both recti which allows herniation of abdominal contents between the anterior rectus sheath and muscle. The aim was describing this defect and its characteristics as well as propose an awareness strategy to avoid symptomatic patients being dismissed after “normal” scan or physical examination. Method A prospective observational study was conducted on 32 patients, between January 2019–2024. Data collected (history, examination, and relevant investigations) was entered in a proforma, tabulated, and analysed. Most of patients presented with discomfort, swelling, intermittent nausea and all reported a bulge. Distension was noted in 42%. On physical examination all had some degree of asymmetry. However no cough impulse or palpable defect was detected. They were mainly diagnosed on CT scans (77%) although some radiology reports denied the presence of a hernia because the anterior sheath was intact. The rest were found incidentally at laparoscopy for unrelated conditions. Most defects were repaired with sutures while larger defects were repaired with mesh. Two patients presented with small bowel obstruction. Conclusion Pfannenstiel hernia is atypical with unique anatomic features and the radiological signs may be subtle. Increased awareness by surgeons and radiologists should avoid this condition being missed. It may be preventable by attention to closing the posterior layer at the index operation.