Interstitial Hernia Research Articles

P-033 COMPLICATIONS IN E-TEP RIVES:OUR SERIE

Abstract Aim To study complications in our e-TEP series in ventral and incisional hernias. Methods We reviewed all patients undergoing e-TEP for ventral or incisional hernias. We included 33 patients (14 M2 or M3W2 incisional hernias and 11 medium ventral hernias with rectus diastasis), in whom polypropylene mesh was used. Follow-up at least 6 months. Results We found 2 patients with interstitial hernia below the mesh, one of them in the acute postoperative period with intestinal obstruction. One patient with recurrence of incisional hernia in the subxiphoid area, one patient with asymmetry of the right hypochondrium, and one patient with a seroma requiring drainage and a hematoma in another (using drainage). Intensive postoperative pain in 6 patients with delayed discharge. Conclusion In our series, E-TEP is safe but not free of complications.We started the procedure very ambitiously with M3W2 incisional hernias, but we soon realized that this technique did not allow us to revise the cavity and perform adhesiolysis, so we changed the way we managed these patients, and became more selective, only indicating E-TEP in medium-sized primary hernias associated with rectus diastasis. We managed to improve surgical skill with the cases, reducing postoperative pain, surgical time and hospital stay.

P-007 ACQUIRED “INTERSTITIAL” HERNIA: A REPORT OF TWO CASES

Abstract Aim Acquired “interstitial” hernias are extremely rare and can be a serious complication after ventral hernia repair with placement of an onlay mesh. Material and Methods We describe two cases of interstitial hernias after onlay repair. Case 1: male patient of 59-year-old was submitted to a segmental enterectomy due to intestinal perforation and developed a hernia that was then surgical repaired with closure and an onlay mesh . Case 2: 58-year-old male with medical history of polimyelitis with two previous umbilical hernia repair interventions, being the last one with an onlay mesh. Both patients at the physical examination revealed a symptomatic bulge difficult to characterize and the CT scan showed multiples defects with the hernia sac between the anterior aponeurosis and the onlay mesh. Results In both cases, the previous mesh was surgically removed, and repair of the abdominal wall was achieved with the placement of a macroporous retromuscular polypropylene mesh with 48mg/m2 density and complete medialization of the rectus muscles. Conclusions The diagnosis of interstitial hernias may be challenging, and CT imaging is mandatory for confirmation. Due to the high risk of complications such as strangulation, these hernias should always be corrected in a timely manner.

Single-incision laparoscopic repair for an arcuate line hernia: a case report

BackgroundThe arcuate line is the inferior margin of the posterior layer of rectus abdominis sheath. An arcuate line hernia is a parietal interstitial hernia consisting of ascending protrusion of intraperitoneal contents above the arcuate line. Arcuate line hernias are rare, and fewer than 20 cases undergoing surgical repair have been reported. Various surgical approaches were used in previous cases, and there is no consensus regarding the ideal repair method. We report the first case of an arcuate line hernia repaired using single-incision laparoscopic surgery.Case presentationThe patient was a 78-year-old man who presented with a history of intermittent lower abdominal quadrant pain of more than 2 month’s duration. He had not previously undergone abdominal surgery, but had a history of mycobacterial lung disease and asthma. His vital signs were normal on presentation, and he experienced no vomiting or nausea. On palpation, his abdomen was flat and soft, and no mass was palpable. However, there was slight tenderness in the right lower quadrant. Blood laboratory test results were within normal ranges. Computed tomography revealed small bowel protrusion between the rectus abdominis and the posterior rectus sheath, and an arcuate line hernia was suspected and subsequently confirmed intraoperatively. The patient underwent single-incision laparoscopic repair with the intraperitoneal onlay mesh technique with tacks and with care to avoid the inferior epigastric vessels. The operation time was 30 min, and no intra- or post-operative complications occurred. Surgery relieved his symptoms, with no recurrence within 1 year postoperatively.ConclusionsSingle-incision laparoscopic surgery was performed easily and successfully in this rare patient with arcuate line hernia. Arcuate line hernia should be considered in patients presenting with abdominal symptoms, and single-incision laparoscopic repair should be considered for repair.

Interstitial incisional hernia of greater omentum: An incidental finding during routine cadaveric dissection

Omental herniation, located between the rectus abdominis muscle and the anterior blade of the rectus sheath, can be triggered after a transverse suprapubic incision. It causes the development of an incisional interstitial hernia (IIH), which is an extremely rare and poorly understood condition. Based on this information, our work presents the first anatomical description of incisional interstitial hernia found during routine dissection at the Human Anatomy Laboratory of the Federal University of Ceará in a formalized female corpse.

A Rare Interstitial Type of Post Appendectomy Incisional Hernia

Intraparietal Hernias are hernias occurring in the anterior abdominal wall at different anatomical planes. An interparietal hernia has a hernial sac that passes between the layers of the anterior abdominal wall. Appendectomy is a very common surgical procedure, and post appendectomy incisional hernia is a very rare complication. Here we present a case of a 24-year-old male with swelling in the right hypochondrium and lumbar region with an open appendectomy scar. He was diagnosed to have an interparietal hernia in the anterior abdominal wall. After obtaining consent patient was taken up for surgery. At surgery, the patient was found to have a defect in the transverse abdominis muscle with a medial leaf far from the incision site. Open repair of the defect along with double breasting of external oblique done. Interparietal hernias are rare in post appendectomy scar and this case is of significance since it Highlights a rare interstitial type incisional hernia, as a complication of post appendectomy scar, and not many cases reports are mentioned in literature.

Congenital Spigelian hernia and ipsilateral cryptorchidism: a new syndrome?

Spigelian hernia (SH) is a rare ventral interstitial hernia occurring through a defect in the transversus abdominis aponeurosis (Spigelian fascia). Spigelian fascia is found between the lateral border of the rectus abdominis muscle and the semilunar line, which extends from the costal cartilage to the pubic tubercle. In other words, Spigelian line is where the transversus abdominis muscle ends in an aponeurosis characterized by a congenital or acquired defect in the Spigelian aponeurosis. Pediatric cases of SH are either congenital or acquired due to trauma, previous surgery or increased intra-abdominal pressure. SH in combination with ipsilateral cryptorchidism may constitute a new syndrome, as such cases are extremely rare in the literature is new syndrome is characterized by the following congenital, ipsilateral disturbances: SH, absence of inguinal canal and gubernaculum and the homolateral testis found within the Spigelian hernia sac (a hernia sac containing undescended testis). The aim of this study is to emphasize some typical findings of this specific entity, and, hence, the necessity for a thorough investigation of the origin of the SH.

Reparación laparoscópica de emergencia de una hernia inguinal intersticial estrangulada, ¿es factible?

Resumen La hernia inguinal estrangulada es una emergencia quirúrgica que requiere de manera tradicional laparotomía urgente. Con el desarrollo de las técnicas quirúrgicas podemos afrontar este problema con un abordaje laparoscópico para valorar la resecabilidad del contenido herniado. Exponemos el caso de una hernia estrangulada en el cual se repara la hernia por laparoscopia y posteriormente se requiere resección. Se exponen los pasos de la técnica quirúrgica.

Open mesh repair of interstitial hernia containing small bowel

Interparietal hernias are rare entities of the anterior abdominal wall in which the hernia sac protrudes between peritoneum, fascia, muscle, or subcutaneous tissue. There are three types of interparietal hernias: interstitial, superficial, and preperitoneal. The interstitial type hernia is rare and involves herniation between the abdominal wall musculature and fascial planes. Diagnosis is rarely made preoperatively, and treatment consists of operative reduction of the hernia sac with primary tissue or mesh repair. Repair of interparietal hernias can be performed open or laparoscopically. We report the case of a 40-year-old male who presented with an incarcerated interstitial hernia which contained small bowel and had developed after open appendectomy performed 20 years prior. The hernia was repaired using the open technique and employed a mesh for reinforcement. The patient tolerated the procedure well and remained free of recurrence.

Strangulated Interstitial Hernia with Strangulated Cryptorchid Testis-First Case Report in the Medical Literature.

Interstitial hernias are a rare subtype of abdominal hernias, where sac is present in between the abdominal wall layers. Although, difficult to diagnose clinically, they are usually detected on imaging studies. Interstitial hernias presenting with undescended testis are common. Even after a meticulous online search of the medical literature, we could not find a case report of 'Strangulation of Interstitial hernia, with a strangulated undescended testis in an elderly man.We hereby present this extremely rare case, and possibly, this could be the first of its kind, case report in the medical literature. Our aim is to present a combination of rare presentations in an elderly cryptorchid person with strangulated interstitial hernia. A 65-year male patient presented with 4 days of pain abdomen and vomiting. He was having features of toxaemia. Ultrasonography revealed interstitial hernia with bowel loops. During surgery, gangrenous bowel loops with the sac between the interstitial planes, with strangulated cryptorchid testis, were found. Strangulated interstitial hernia in elderly cryptorchid person, leading to the strangulation of the undescended testis, is extremely rare, and this could be the first case reported in the medical literature.

Small Bowel Obstruction Secondary to Interstitial Hernia: Laparoscopic Approach.

Interstitial hernias are a rare entity. Most of them are detected incidentally on imaging studies. We present a case of abdominal bowel obstruction secondary to interstitial hernia on the fifth postoperative day of an open incisional hernia repair. Laparoscopy confirmed the diagnosis and led to an accurate treatment avoiding a new laparotomy. In this case, prompt surgical decision based on clinical and CT scan findings allowed a mini-invasive approach with satisfactory outcome.

Congenital Spigelian hernia associated with undescended testis

A Spigelian hernia (SH) is a ventral interstitial hernia through a defect in the Spigelian fascia; an undescended testis is sometimes associated with this clinical entity in male newborns. The etiopathogenesis, surgical anatomy, diagnostic methods, and treatment for this rare condition are discussed with a review of the literature. A 20-day-old newborn was admitted to our hospital for a swelling in the right lower abdomen and undescended testis. Physical examination of the abdomen and scrotum revealed a congenital SH associated with cryptorchidism. Herniotomy, herniorrhaphy, and orchidopexy were performed. In the post-operative period, scrotal abscess occurred and was drained. After drainage, the fixed testis was found to be atrophic. This association may be a distinct clinical syndrome. The operation time in cases of neonatal SH with undescended testis should be well planned because of probable surgical complications such as vascular damage, tension, or compression.

Postoperative interstitial hernia as a cause of obscure incisional wound site pain.

An interstitial hernia is one in which the hernia sac is located between the layers of the abdominal wall. The analysis of contemporary literature shows that interstitial hernias are most often seen in children as a type of inguinal hernia and often accompany undescended testis. The hernia sac is usually located between the external-oblique and internal-oblique muscles in a lateral-cephalic direction. The authors present 3 cases of interstitial hernia found during laparoscopic exploration of the front abdominal wall done due to incisional wound site pain. No previous diagnosis of hernia was considered in all the cases. Hernias were found as complications of appendectomy and wound healing after radiotherapy of uterine and cervical cancer. In conclusion, in obscure wound site pain, the presence of an interstitial postoperative hernia should be considered as a possible reason for the complaint. Laparoscopic examination of the anterior abdominal wall during adhesiolysis in patients with abdominal pain enables proper diagnosis and treatment.

Laparoscopic repair of a large interstitially incarcerated inguinal hernia.

A 68 year old female presented for elective repair of an abdominal wall hernia. Preoperative CT imaging revealed a right inguinal hernia defect with hernia contents coursing cephalad between the external and internal abdominal oblique muscles. This was consistent with an interstitial inguinal hernia, a rare entity outside of post- traumatic hernias. At operation the hernia contents were reduced laparoscopically. The hernia was then repaired by transitioning to the totally extraperitoneal (TEP) approach using a 15cm X 15cm piece of polyester mesh. The patient had an uneventful recovery. Interstitial hernias are rare, difficult to diagnose and potentially dangerous if left untreated. There is no consensus on the ideal repair of these unique hernias. This represents a minimally invasive repair of an unusual hernia, with a novel approach to diagnose and manage the hernia and its redundant sac.

Interstitial incisional hernia following appendectomy

Appendectomy is a common surgery and incisional hernia following appendectomy is uncommon, occurring in less than 0.12% of patients [1]. Post appendectomy interstitial incisional hernia is extremely rare [2]. In 1911, Hoguet first called attention to the occurrence of right inguinal hernia following appendectomy with drained wounds. Many of these had not only a right inguinal hernia but also an associated postoperative hernia at the site of the appendectomy scar. Hoguet and Watson attributed the occurrence of the inguinal hernia to a weakening of the abdominal wall following injury to the ilio-inguinal and ilio-hypogastric nerves [3]. A case of post appendectomy interstitial hernia is reported for the rarity of the condition and review of literature.

Unusual hernia in a colostomy closure site

This is a case report of an interstitial hernia following previous transverse loop colostomy closure. There are no reported cases in the literature of gangrenous gall-bladder as the content of an interstitial hernia. This condition can present as a diagnostic challenge. We present a case with a previous reversal of a colostomy in the right upper quadrant presenting with a short history of a right iliac fossa mass and tenderness. Clinically, the patient was septic without any peritonitis. Subsequent computed tomography scan suggested the hernial sac contained gall-bladder and loops of bowel. At surgery, a gangrenous gall-bladder was found within an interstitial incisional hernia (between the external and internal oblique muscle). Retrograde cholecystectomy was performed and bowel and hernia were reduced. The hernia was repaired in layers and patient had an uneventful recovery.

Multidetector computed tomography features of linea arcuata (arcuate-line of Douglas) and linea arcuata hernias

The aim of the study was to estimate the prevalence of delineation of semi circular or linea arcuata (arcuate line of Douglas) (LA) during 64-row multidetector Computed Tomography (mdCT) of the abdomen and to illustrate the so-called linea arcuata hernia (LAH), a peculiar type of interstitial parietal hernia of the anterior abdominal wall consisting of an ascending protrusion of intraperitoneal structures under the LA. The mdCT abdominal wall anatomy of a continuous series of 315 unselected patients was retrospectively reviewed and explored with multiplanar reformations (MPR). Considering a grade 1 lesion (G1) as a single delineation of the LA due to minimal bulging of intraperitoneal fat, a grade 2 hernia (G2) as a substantial herniation under the LA and grade 3 hernia (G3) as a frank prominent herniation of peritoneal structures (essentially omental fat and/or intestinal loops), lesions of all types were found in 8.57% of patients with more than 81% of lesions being G1; this prevalence reached 14.97% in men but only 1.35% in women (M:F sex ratio 12.5:1); all lesions were found in patients older than 51 years and 76% of them were older than 71 years with a great majority of men. Most patients were absolutely free of symptoms related to theses abnormalities. The anatomy of the rectus abdominis sheath and LA are reviewed and the mdCT signs of LA and LAH are described and illustrated. In conclusion, 64-row mdCT can frequently delineate the linea arcuata (LA) and more rarely linea arcuata hernias (LAH), particularly in old men, but these abnormalities mostly represent fortuitous asymptomatic findings.

Co-morbidity and interstitial herniation in the adult: an hypothesis

Whereas interstitial hernias of infancy are a result of congenital abnormalities, those in adults have been blamed on anatomical banding. Many of the latter are associated with systemic, genetic, or acquired connective tissue disease, however. This results in attenuated aponeuroses, ruptured tendons, and atrophied fascia from collagen malformation and destruction. Muscle contractility is compromised by loss of connective tissue septae, reducing capillary density. The result is wasting and disaggregation, which explains interstitial defects filled with herniated extraperitoneal fat, which account for 1% of primary inguinal herniae. These were originally described in the transversus and internal oblique musculature by Hessert (Surg Gyn Obstet 16:566-568, 1913). Similar slits are seen with Spigelian herniae, all of which are interstitial. This hypothesis, if proven, would imply treatment of the pervasive co-morbidity with the protrusions.

Interstitial hernia: A report of four cases in infants

Interstitial hernia: A report of four cases in infants

Interstitial hernia: A report of four cases in infants

Interstitial hernia: A report of four cases in infants

Strangulated interstitial hernia in a female

Strangulated interstitial hernia in a female