Lateral Hernia Research Articles

The treatment of Spigelian hernia in children

An 11-year-old girl with a Spigelian, i.e., spontaneous lateral ventral hernia, is reported. This rare entity has been previously described in only nine children. Five of them had true Spigelian hernias, in which surgery was the treatment of choice. Four hernias were the consequence of trauma, in which cases surgery could be delayed because spontaneous closure eventually occurred.

Lateral Inguinal Hernia Detected on Routine Bone Scan

Lateral Inguinal Hernia Detected on Routine Bone Scan

Size of Lumbar Disc Hernias Measured Using Computed Tomography and Related to Sciatic Symptoms

The change in the relative size of lumbar disc hernias and its relation to sciatic symptoms was investigated in 30 consecutive patients after conservative treatment of CT verified lumbar disc herniations. CT and clinical examination were performed before the start of therapy (CT1), as well as 3 months (CT2) and 24 months (CT3) after institution of treatment. In each patient the size of the lumbar disc herniation in relation to the size of the spinal canal was measured on identical CT slices and expressed as an index. The disc herniation index decreased markedly from CT1 to CT2 (p < 0.001). Between CT2 and CT3 the reduction of the hernias was less pronounced and not significant for hernias located centrally but still significant for intermediate (p = 0.03) and lateral (p = 0.04) hernias. The degree of sciatic symptoms also decreased markedly between CT1 and CT2 (p = 0.001) while no further improvement occurred from CT2 to CT3. There was a significant positive correlation between the improvement from sciatic pain and the reduction in the size of the individual hernia (CT1–CT2 p = 0.02, CT2–CT3 p < 0.001). Thus, the disc herniation index provided a method to study the anatomic effect of conservative treatment as well as a method to evaluate sciatic symptoms in relation to anatomic changes.

Size of Lumbar Disc Hernias Measured Using Computed Tomography and Related to Sciatic Symptoms

The change in the relative size of lumbar disc hernias and its relation to sciatic symptoms was investigated in 30 consecutive patients after conservative treatment of CT verified lumbar disc herniations. CT and clinical examination were performed before the start of therapy (CT1), as well as 3 months (CT2) and 24 months (CT3) after institution of treatment. In each patient the size of the lumbar disc herniation in relation to the size of the spinal canal was measured on identical CT slices and expressed as an index. The disc herniation index decreased markedly from CT1 to CT2 (p less than 0.001). Between CT2 and CT3 the reduction of the hernias was less pronounced and not significant for hernias located centrally but still significant for intermediate (p = 0.03) and lateral (p = 0.04) hernias. The degree of sciatic symptoms also decreased markedly between CT1 and CT2 (p = 0.001) while no further improvement occurred from CT2 to CT3. There was a significant positive correlation between the improvement from sciatic pain and the reduction in the size of the individual hernia (CT1-CT2 p = 0.02, CT2-CT3 p less than 0.001). Thus, the disc herniation index provided a method to study the anatomic effect of conservative treatment as well as a method to evaluate sciatic symptoms in relation to anatomic changes.

Herniendiagnostik durch Peritoneographie

Peritoneography was performed in 1200 patients with ill-defined complaints concerning the abdominal wall, the groin or the pelvic floor. The purpose was to exclude or demonstrate the presence of a hernia. Amongst 750 patients, abnormalities were found in 53.5%. The examination was also carried out post-operatively in order to demonstrate possible recurrences which were not clinically obvious. Amongst 450 patients, a recurrence or a contra lateral hernia was demonstrated in 44%. These results show that a recurrence can only be demonstrated or excluded with certainty by means of peritoneography. The radiological examination is technically straightforward, can be carried out in a few minutes on an out patient basis and is simple for the patient.

Lateral inguinal hernia detected in the early images of three-phase bone imaging.

Lateral inguinal hernia detected in the early images of three-phase bone imaging.

HERNIA SEMICIRCULARIS—AN UNUSUAL LATERAL VENTRAL HERNIA

Two patients are described with an unusual lateral ventral hernia which we have named hernia semicircularis. The distinctive features of this hernia are detailed.

Continuous, Looped Nylon Wound Closure

To the Editor .—We developed a technique for the secure closure of abdominal incisions using mass approximation of the tissues by a continuous, looped, monofilament, nonabsorbable suture. In a prospective series of 284 cases followed for at least six months, an early dehiscence rate of 0.7% and a late hernia rate of 1.1% were detected. These figures are similar to rates cited in the recent literature using other methods of closure. Incisions were approximated as a mass closure incorporating both fascia and peritoneum in a running suture. The suture was constructed of 183 cm of 0 nylon swagged onto a needle (XLH) to provide a usable suture length of 91.5 cm. The suture was prepared by Ethicon (Somerville, NJ) for this purpose (Fig 1). We attempted to obtain a suture-to-wound-length ratio of at least 3:1 to achieve a firm but relaxed closure. When, for technical reasons, the peritoneum could not

The herniographic appearance of direct inguinal hernias in adults.

Inguinal hernias can be demonstrated by positive contrast herniography in children and adults. In this latter age-group direct inguinal hernias are frequent and can appear with different location and shape. In this series of 39 inguinal hernias in 25 adults five different types could be distinguished, according to location. Lateral direct inguinal hernias were found protruding in an anterior direction from the medial inguinal fossa. Inguinofemoral hernias protruded in a mainly inferior direction from the medial inguinal fossa. Medial direct inguinal hernias protruded from the lateral region of the supravesical fossa just medial to the medial inguinal fold. Diverticular direct inguinal hernias were located in the medial aspect of the supravesical fossa. Supravesical inguinal hernias were located in the mid-line. The distinction between these direct hernias and their relation to and distinction from other hernias in the inguinal region is discussed.

Spigelian hernias: anatomy and roentgenographic manifestations.

The anatomy of an uncommon but important type of lateral ventral hernia is reviewed. The key radiographic findings are air or contrast filled bowel seen laterally outside the confines of the peritoneal cavity, the “beak sign” of hernia, the sharp constriction of the proximal herniated loop, and the intermittent nature of the hernia. The setting in which to consider this diagnosis—acute bowel obstruction, intermittent abdominal pain, and “vanishing masses”—is discussed. The alert radiologist can suggest this diagnosis in cases in which the lesion is not found or appreciated by the clinician.

The Spigelian hernia: radiographic manifestations.

The Spigelian hernia is a form of spontaneous lateral ventral hernia which occurs in the linea semilunaris (Spigelius' line) due to developmental or acquired weakness of fibres of the internal oblique and transversus abdominis muscles. Spigelian hernias most frequently occur at the junction of the linea semilunaris and the linea semicircularis of Douglas and therefore most commonly present as small intramural masses situated at the lateral margin of the rectus sheath approximately halfway between the umbilicus and the pubic symphysis. They most often contain omentum, rarely intestine and are frequently asymptomatic. Their presentation as a primary cause of intestinal obstruction is rare. In view of these anatomical and clinical characteristics, the pre-operative radiographic recognition of an obscure lower abdominal, paramedian mass as a Spigelian hernia may be of considerable clinical significance, particularly in the absence of an obvious defect or surgical scar in relationship to the mass. The case des...

A case of lateral hernia of the caecum, excision of the caecum and ascending colon

Abstracts. Surgery.In a patient operated on for an inguinal hernia and an unnatural anus of the left labia majora with prolapse of the intestinal mucosa, the contents of the hernia turned out to be part of the large intestines (which forms the anus praeternatur., Instead of a separate ascending loop) small intestine.