Hernia Research Articles

Amyand's Hernia a form of Inguinal Hernia: A Case Report and Literature Review

Introduction: Amyand hernia (HA) is a form of inguinal hernia considered to be very rare, and this type of hernia has occurred up to 1% of all inguinal hernia cases. In this type of inguinal hernia, the contents of the hernia is the appendix. Most patients with HA often remain asymptomatic and diagnosed intraoperatively. The diagnosis is difficult, surgery is the pillar of management. We report a case of Amyand hernia that was operationally managed in our institution. Case Report: A 50-year-old patient with a normal body mass index (BMI) with a history of right-side reducible inguino-scrotal hernia that has evolved for 4 years, he was admitted for management of elective right inguinal hernia. Two weeks before admission, he noticed worsening pain. Normal abdominal ultrasound. There was no history of abdominal pain and vomiting. The biological assessment was normal. So, with a diagnosis of partially reducible right inguinal hernia, incomplete and indirect, the patient was operated on surgical exploration, we found dense adhesions in the sac, and adhesiolysis was released which revealed a hernia of the appendix in the inguinal canal. The appendix was slightly congested with no signs of inflammation. Therefore, given the uninflated appendix, a hernia cure according to Lichtenstein with an appendectomy was performed. Simple post-operative follow-up. Clinical Conclusion: Amyand’s hernia, is a condition where the appendix is found in the hernia sac, is quite rare, accounting for only 0.4–1% of all instances of inguinal hernia. A review of the literature further emphasizes the rarity of Amyand’s hernia. Moreover, a mere 0.1% of these cases progress to acute appendicitis, often as a result of delayed presentation and overlooked diagnosis. Conclusion: Amyand’s hernia (AH) constitutes a minor percentage of all inguinal hernia cases, and its identification often occurs unexpectedly during surgery. This condition can stay symptom-free and mimic a typical inguinal hernia. .......

Congenital Lumbar Hernia Associated with Lumbocostovertebral Syndrome

Congenital Lumbar Hernia Associated with Lumbocostovertebral Syndrome

Previously unrecognized Morgagni’s hernia presenting with bowel obstruction: a rare case report

Introduction and importance: Morgagni’s hernia (MH) is a rare entity, it is defined by the protrusion of abdominal viscera through an anterior retrosternal diaphragmatic defect. It is mainly diagnosed during the perinatal and neonatal periods. A few cases have been reported in adults. The objective of this study was to report the case of a patient with an unrecognized MH, review the current literature on Morgani hernias in the adult population, and assess their clinical characteristics and therapeutic approach reported in adults. We here describe a rare case of a MH presenting with bowel obstruction as the primary symptom in adult life. Case presentation: A 52-year-old man presented to the emergency department with a bowel obstruction. The abdominal CT tomography showed an intestinal bowel obstruction above the hiatal hernia with an intrathoracic ascending colon. Exploratory laparotomy revealed a bilateral strangulated diaphragmatic hernia of Morgagni. The patient underwent closure of the diaphragmatic defect under tension by X-stitch. The recovery was uneventful, and the patient is in good health after 12 months of follow-up. Clinical discussion: The Morgagni hernias are usually asymptomatic; complications such as strangulation of the herniated colon or herniated stomach by stricture are exceptional. Surgical treatment is always recommended for MH. Postoperative complications are rare in simple diaphragmatic hernias, and the course is generally favorable. Conclusion: MH is the rarest form of congenital diaphragmatic hernia, with nonspecific symptomatology contributing to the delay in diagnosis. The cure is surgical, and the open surgical approach is preferable in emergency cases, while laparoscopic surgery is favored in elective settings and is associated with shorter hospitalization. Further studies are crucial in order to elucidate etiology and optimal therapeutic approach.

Open repair of flank and lumbar hernias: 142 consecutive repairs at a high-volume hernia center

BackgroundFlank and lumbar hernias (FLH) are challenging to repair. This study aimed to establish a reproducible management strategy and analyze elective flank and lumbar repair (FLHR) outcomes from a single institution. MethodsA prospective analysis using a hernia-specific database was performed examining patients undergoing open FLHR between 2004 and 2021. Variables included patient demographics and operative characteristics. ResultsOf 142 patients, 106 presented with flank hernias, and 36 with lumbar hernias. Patients, primarily ASA Class 2 or 3, exhibited a mean age of 57.0 ​± ​13.4 years and BMI of 30.2 ​± ​5.7 ​kg/m2. Repairs predominantly utilized synthetic mesh in the preperitoneal space (95.1 ​%). After 29.9 ​± ​13.1 months follow-up, wound infections occurred in 8.3 ​%; hernia recurrence was 3.5 ​%. At 6 months postoperatively, 21.2 ​% of patients reported chronic pain with two-thirds of these individuals having preoperative pain. ConclusionsOpen preperitoneal FLHR provides a durable repair with low complication and hernia recurrence rates over 2.5 years of follow-up.

Impact Of Comorbidities On Outcomes And Healthcare Costs Of Open Inguinal Hernia Repair In Patients With Diabetes Mellitus.

Inguinal hernia management in patients with diabetes mellitus (DM) and comorbidities presents challenges due to potential impacts on wound healing and infection risk. This study evaluates the influence of additional comorbidities on outcomes following open inguinal hernia repair in DM patients. A retrospective cohort study was conducted at Craiova Emergency Clinical County Hospital from 2015 to 2020. Patients with documented DM undergoing hernia repair were categorized into two groups based on comorbidity status. Data on presentation mode, hernia type, comorbidities, hospitalization, operative details, postoperative outcomes, and costs were collected and analyzed statistically. Among 38 DM patients undergoing hernia repair, 16 were in Group A (DM alone) and 22 in Group B (DM with comorbidities). Group B patients were older (p = 0.0002) and more likely to present emergently (OR: 13.81, p=0.0148) with incarcerated (OR: 22.733, p=0.0339) or strangulated hernias (OR: 9.4545, p=0.0390). Group B had longer hospitalizations (p=0.00132) and higher hospitalization costs (p = 0.00262). DM patients with comorbidities are at higher risk for complex hernias and prolonged hospitalizations. Pulmonary fibrosis emerges as a significant comorbidity requiring specific perioperative strategies. Tailored preoperative assessments and care plans can optimize outcomes.

Strangulated ventral hernia through peritoneal dialysis catheter orifice

Strangulated ventral hernia through peritoneal dialysis catheter orifice

ANGIOEMBOLISATION OF CREMASTERIC ARTERY FOR SCROTAL HAEMATOMA FOLLOWING HERNIAL REPAIR

Cremasteric artery is a branch of inferior epigastric artery supplying the cremaster muscle and coverings of the cord. The possible consequence of injury to this artery is scrotal haematoma. We present a case of haemorrhage from unexpected cresmastric artery injury post-hernioplasty treated with angioembolisation. To the best of our knowledge, this has not been reported in literature.
 A 66-year-old gentleman with left indirect inguinal hernia underwent a left inguinal hernioplasty in our institution with no immediate complications. However he presented to the emergency department the day after the procedure with complaints of rapidly worsening painful left scrotal swelling accompanied with symptoms of intestinal obstruction. Emergency laparotomy and re-do left hernioplasty was performed, revealing a strangulated inguinoscrotal hernia. Post-operatively, there was non-resolving scrotal swelling with a drop in the haemoglobin level; from 11.9g/dl to 8.5g/dl requiring packed cell transfusion. CT angiogram revealed active contrast extravasation from the left cremasteric artery. Angiographic run confirmed the finding and the left cresmatric artery was superselectively cannulated with a 1.9Fr microcatheter and embolization done with 0.5mm microcoil. Ultrasound scan 24-hour post-procedure showed patent proximal vessel. Clinically there was a reduction of the left scrotal swelling and the haemoglobin remained stable. 
 Cremasteric artery courses laterally deep into the fascia transversalis entering the cord deep to the internal spermatic fascia to supply the cremaster muscle and coverings of the cord. This course renders the artery to be prone for injury during procedure such as hernioplasty; one of the possible consequences is scrotal haematoma. This artery is usually small in caliber and its identification is important for efficient and effective treatment.
 Angioembolisation is able to treat this injury with superior precision owing to its ability for localization and selective cannulation of the offending vessel.

The Australian Medical Journal, August 1846.

Medical journals started appearing formally in Europe in the 17th century and in North America in the 18th century. In Australia, the first issue of Australian Medical Journal (AMJ) was issued in Sydney, under the stewardship of a New South Wales (NSW) senior surgeon William Brooks working in Newcastle (NSW) in August 1846. This article refers to that issue of AMJ exploring its contents and context. In terms of original articles, only one on the surgical procedures carried out on two patients suffering strangulated hernias in the Parramatta-Public Hospital by Surgeon Thomas Robertson occurs. The other inclusions are précis from contemporary British medical journals. The AMJ appeared only for a year; why it ceased publication in 1847 is not clear. It was resurrected by the Medical Society of Victoria, Melbourne in 1856, issuing 40 annual volumes uninterruptedly until 1895. With the incorporation of other regional Australian medical journals, AMJ was re-named as the Medical Journal of Australia (MJA) in 1914. As MJA, it continues to perform to-date. Natl Med J India 2023;36:263-8.

Obstruction of Small Bowel due to Strangulated Obturator Hernia: Case Report

Introduction: Obturator hernia is one of the rare types of hernia and the important cause of small intestine obstruction. It mostly occurs in elderly people and women. This disease is challenging to diagnose and has a high mortality rate. Cese Presentation: In this study, two patients are introduced. The first patient was a 95-year-old woman who came with symptoms of gastrointestinal obstruction, nausea, bilious vomiting, as well as lack of gas and stool excretion. There was no suspicious pathological examination. The computed tomography (CT) scan was performed for the patient with the report of the left Obturator hernia. The second case is an 88-year-old woman with a history of neurological problems and symptoms of gastrointestinal obstruction, who had tenderness and rebound tenderness of the right lower quadrant of the abdomen during the examination. Since imaging findings were normal, the CT scan was performed for the patient, and the report was in favor of the right obturator hernia. Both patients underwent surgery with a midline incision of the abdomen. The small intestine was gangrenous at the hernia site and did not have proper peristalsis. Therefore, she underwent resection and anastomosis of the small intestine and repair of the obturator hernia. Conclusion: Obturator hernia is a rare but significant cause of intestinal obstruction, especially in emaciated elderly women. The diagnosis of this disease is challenging for doctors. One of the appropriate methods for diagnosing this disease is a CT scan of the abdomen and pelvis, and the only treatment method is surgery.

Case Report: Ultrasound Guided Neuraxial Anaesthesia in a Patient with Severe Scoliosis and Large Lumbar Hernia

Case Report: Ultrasound Guided Neuraxial Anaesthesia in a Patient with Severe Scoliosis and Large Lumbar Hernia

Endoscopic retroperitoneal repair of superior lumbar hernia (Grynfeltt hernia) using self-fixating mesh to prevent nerve injury: a case report

BackgroundThe primary superior lumbar hernia, also called the Grynfeltt Hernia, is a rare entity; hence, a standard surgical repair method has not been established. It is important for this repair procedure not only to prevent recurrence by placing an adequate size of mesh but also to avoid nerve injury. The endoscopic retroperitoneal approach is considered a useful technique for this procedure, requiring no mobilization of the colon and providing good visibility of the surrounding nerves. A self-fixating mesh does not require a traumatic fixation, which is considered advantageous for nerve preservation.Case presentationA 72-year-old woman, complaining of left lumbar swelling, was diagnosed with a primary left superior lumbar hernia and underwent endoscopic retroperitoneal hernia repair. With the patient in the right lateral decubitus position, five small ports were inserted, and the retroperitoneal space was dissected. The 2.0 × 1.0-cm hernial orifice was found, and the 12th subcostal nerve above the hernial orifice and the iliohypogastric and the ilioinguinal nerves below the hernial orifice were identified. A 15 × 10-cm self-fixating mesh was placed in the retroperitoneal space without mesh tacking. The postoperative course was uneventful, and the patient was discharged on the first postoperative day. Two years after surgery, there was no sign of recurrence, and chronic pain and neuropathic symptoms were absent.ConclusionsEndoscopic retroperitoneal repair of primary superior lumbar hernia using a self-fixating mesh seems to be useful for nerve preservation.

Complex management of larger strangulated incisional hernia in a post-multiple abdominal surgery in a morbidly obese patient-a case report and surgical review

Strangulated incisional hernia following a post-hernia repair is a serious and potentially rare life challenging condition that can occur after surgical intervention. Incisional hernias accounts for 15-20% of all abdominal hernias which occur at the site of a previous surgical incision where the integrity of the fascia has not been fully restored. We are presenting a case report of a 49 years lady who came with complaints of abdominal swelling and pain abdomen following multiple abdominal surgeries diagnosed with strangulated incisional hernia following post hernia repair. It was managed by emergency surgical intervention that is removal of previously kept mesh and resection of gangrenous segment of bowel with end ileostomy after keeping overall patient’s condition.

An inguinal surprise: strangulated femoral hernia

Femoral hernias account for 2% to 4% of groin hernias, are more common in women, and are more appropriate to present with strangulation and require emergency surgery. This condition may lead to symptoms of bowel obstruction or strangulation and possible bowel resection-anastomosis. There are few reports of strangulated femoral hernia. Femoral hernias, often, are usually delegated to a secondary differential or if even rarer not considered at all during dubious presentations as groin swellings which are irreducible without the classical features which have usually been described in our surgical literatures, Inguinal being forefront for diagnosis. We herein present a 45-year-old female had come to the outpatient department at MVJ MC and RH with the complaints of swelling in the left groin for 5 years and pain for 8 days sudden onset with irreducibility, with no features of small bowel obstruction. She was diagnosed as having a left side obstructed inguinal hernia after appropriate radiological investigations and underwent inguinal exploration. Intraoperative diagnosis of left sided strangulated femoral hernia with omentum as its content was made. Omentectomy with herniorrhaphy was done and post-operative period was uneventful, and patient was discharged with regular follow up. Femoral hernias are more common in women and lead to a substantial over risk for an emergency operation, and consequently, a higher rate of bowel resection and mortality. Femoral hernias should be operated with high priority to avoid incarceration and be repaired with a mesh.

Emergency transabdominal preperitoneal (TAPP) repair of a strangulated obturator hernia: A literature review and video vignette.

Obturator hernia (OH), a rare and potentially life-threatening condition, presents diagnostic and therapeutic challenges. This review article comprehensively delves into the clinical features, diagnosis, and management of OH, with a particular emphasis on the pivotal role of computed tomography (CT) in timely and accurate diagnosis. Delays, particularly in contrast-enhanced CT, dramatically increase mortality due to potential bowel strangulation. To illustrate the challenges and complexities surrounding OH, we present a video vignette of a 74-year-old female patient who presented with symptoms suggestive of bowel obstruction (BO) secondary to a strangulated left-sided OH. This patient case complements the theoretical framework established in the review, serving as a practical example for healthcare professionals. Her presentation included abdominal pain, absence of flatus and bowel movements, and abdominal distension. Laboratory tests demonstrated a mildly elevated white blood cell count and C-reactive protein. CT imaging confirmed the diagnosis of a strangulated OH with an ischemic small bowel. An emergency laparoscopy was undertaken, and the hernia was repaired using the transabdominal preperitoneal approach. A portion of the ischemic small bowel was resected through a 5-cm extension of the umbilical port, and an anastomosis was performed using a modified Barcelona technique. The surgery was successfully completed without immediate or long-term complications. This case highlights the crucial role of timely CT diagnosis and minimally invasive surgical management in achieving improved outcomes in acute BO secondary to OH, particularly when facilitated by pre-operative CT planning.

A PHYSIOTHERAPY MANAGEMENT IN CASES OF LUMBAL NUCLEUS PULPOSUS (HNP) HERNIA USING MICROWAVE DIATHERMY (MWD) AND MC MODALITY KENZIE EXERCISE

Background: Pulpous Nucleus Hernia (HNP) is a condition where protraction occurs in the intervertebral disc due to injury or excessive mechanical load. HNP is a condition where the nucleus pulposus in the annulus fibrosus comes out or protrudes, puts compression on the nerves, and causes radicular pain, motor weakness, numbness, or tingling. Mc.Kenzie Exercise and the use of Microwave Diarrhea (MWD) modalities to overcome this problem. Microwave Diathermy (MWD) reduces pain caused by damaged tissue or abnormal tissue by stimulating the nociceptors, while giving McKenzie exercise aims to improve normal posture in the vetebra, reducing pressure on the intervertebral disc and vetebra ligaments. Method: The research method is a case study to determine the management of physiotherapy in cases of Lumbar Hernia Nucleus Pulposus (Hnp) Using Microwave Diathermy (Mwd) and Mc. Kenzie Exercise Results: Management of the physiotherapy process during 9 meetings using Microwave Diathermy (MWD) and Mc. Kenzie Exercise in lumbar HNP patients has been carried out according to standards with surgery, resulting in increased joint range of motion and increased functional activity. Conclusion: MWD modality, Mc. Kenzie exercise in HNP patients can increase the range of joint movement and functional activity in patients
 Keywords: Microwave diathermy (MWD), Mc. Kenzie exercise, Hernia Nuckleus Pulposus (HNP)

Clinical characteristics and assessment of the frequency of complications after surgical treatment of patients with free and strangulated hernias using synthetic implants

Objective. To give a clinical assessment and conduct a comparative analysis of the frequency of postoperative complications in patients with free and strangulated hernias of various localizations after tension-free hernioplasty using synthetic implants.Materials and methods. A retrospective analysis of 965 medical records of inpatient patients who underwent tension-free hernioplasty for hernias of various localizations in the period from 2018 to 2022 was carried out. The results of the study were processed using applied statistics using MS Excel and a software package for statistical analysis “Statistica v. 10.0”. Statistically significant differences were considered at p < 0.05.Results. The study revealed that in the postoperative period after tension-free hernioplasty in patients with strangulated hernias, the complication rate was 15.8%. At the same time, the frequency of complications was higher after “onlay” hernioplasty in patients with strangulated hernias than in patients with free hernias. The frequency of postoperative complications in patients with impaired postoperative ventral hernias is 8.3 times higher than in patients with free postoperative ventral hernias. In the postoperative period, complications such as seroma and infiltration of the postoperative wound were detected in 10.5 and 5.2% of cases in patients with strangulated hernias. The duration of inpatient treatment for patients with complications after hernioplasty is 2.6 times longer compared to patients without complications (p < 0,05).Conclusion. In the postoperative period, in patients with strangulated hernias, the incidence of complications was observed in 15.8% of cases, and in patients with free and irreducible hernias in 1.5% of cases. Clinically, such postoperative complications as seromas, infiltrates of the postoperative wound, ligature fistulas, scrotal hematoma, orchitis, abscess of the postoperative wound were identified.

Management of strangulated inguinal hernias in a district hospital: About 73 cases

Abstract BACKGROUND: Hernial strangulation is a surgical emergency characterized by tight, permanent constriction of the contents of the hernial sac. It is also called an irresistible hernia with impairment of perfusion. This work aims to evaluate the results of the management of strangulated hernias in a district hospital. METHOD: This was a cross-sectional study with prospective descriptive and analytical collection carried out in the General Surgery Department of Tessaoua District Hospital (Maradi, Niger), covering patients operated on for strangulated inguinal hernias managed from January 2020 to February 2022. RESULTS: We collected 73 cases of strangulated hernias representing 2.76% of admitted surgical emergencies and 1.92% of surgical procedures. The mean age was 49.30 years with extremes ranging from 20 to 80 years and a standard deviation of ±17.21. The sex ratio was 8.13. The admission time was less than 6 h in 45.21% of cases, between 6 and 9 h in 38.36% and more than 9 h in 15.07%. On exploration, the contents were of normal appearance in 61.64%; 17 cases whose contents were already necrotic, that is 23.29%, and 11 cases of sphacelic appearance, that is 15.07%. Anastomotic resection was performed in 21.92% of cases, followed by Desarda in 26.03% and Mac Vay in 12.33%. The average hospital stay was 7 days. CONCLUSION: Strangulated hernia is a frequent pathology in developing countries. Patients with a simple hernia must go for consultation, hence the importance of raising awareness for early management.

Incisional Hernia with Rare Finding of Liver as Content: A Case Report

Lumbar incisional hernia is an uncommon complication that affects the abdominal wall integrity, accounting for approximately 3.5% of all cases. It typically occurs following open nephrectomy or aortic aneurysm repair surgeries. Although rare, lumbar hernias can lead to discomfort, aesthetic issues, or even intestinal obstruction. In extremely rare cases, lumbar herniation of the liver can occur. Here, the authors present a case of a 60-year-old female patient with liver herniation through a lumbar incisional hernia and a history of pyelolithotomy for renal calculi. The authors performed an open hernia repair with meshplasty. Lumbar incisional hernias are rare and still difficult to manage. Computed tomography is the diagnostic method of choice in the evaluation of the parietal wall defect to choose the appropriate therapeutic management. Surgical management modalities are still poorly codified, with no precise recommendations, and this is probably due to the relative rarity of the cases.

Maternal Strangulated Diaphragmatic Hernia with Gangrene of the Entire Stomach During Pregnancy: A Case Report and Review of the Recent Literature [Response to Letter

Maternal Strangulated Diaphragmatic Hernia with Gangrene of the Entire Stomach During Pregnancy: A Case Report and Review of the Recent Literature [Response to Letter

ЭКСПЕРИМЕНТАЛЬНОЕ ИССЛЕДОВАНИЕ ПРИМЕНЕНИЯ ОРИГИНАЛЬНОГО ФИБРИНОВОГО КОМПОЗИТА В ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ БОЛЬНЫХ С БОЛЬШИМИ ПОСЛЕОПЕРАЦИОННЫМИ ГРЫЖАМИ

Introduction. The increase in the number of abdominal surgeries with laparostomy formation in recent years has been accompanied by an increase in the number of postoperative ventral hernias. Mortality in this category of patients ranges from 0.1 to 2.9% for planned surgeries and from 10 to 26% for strangulated hernias. One of the reasons is implant suppuration in the postoperative wound with subsequent septic complications and increasing antibiotic resistance of pathogenic microorganisms. Objective. To experimentally study the effectiveness of using the original fibrin composite to improve the adaptation of the mesh implant in the tissues of the anterior abdominal wall in the treatment of postoperative ventral hernias. Material and methods. The experimental in vitro study included studying the process and mechanisms of fibrin clot formation when various components to human plasma cryoprecipitate. The second stage of the study was to study the effect of surgical trauma and the introduced components of the fibrin composite on the formation of fibrous tissue. In a bacteriological laboratory, the risk of infection of a mesh implant treated with cryoprecipitate and its effect on E growth. Coli, St. Aureus, and P. Aureginosa colonies were studied. In the clinic, 60 patients with large postoperative ventral hernias were operated on, including 39 women and 21 men. In the main group, 30 patients underwent herniotomy and implant installation, and the original fibrin composite was applied. In the comparison group, 30 patients underwent a herniotomy in a modification of the Belokonev operation. The average age of the patients in both groups was 63±2.8 years. Results. When thrombin is added to the cryoprecipitate in in vitro experiments, a dense clot is formed which in the early stages is well modeled on a polypropylene mesh, subsequently forming a fibrin coating. The fibrin composite has a bacteriostatic effect, which helps to prevent infection and suppuration of the implant in the future. In the patients operated in the main group, the immediate postoperative period was without complications. In the comparison group, a long period of leukocytosis was observed in the postoperative period. Conclusions. The original fibrin composite has a bacteriostatic effect and prevents active microflora growth of microflora in the postoperative wound. The original fibrin composite covers the mesh implant, promoting rapid fibrous tissue. The use of this technology in the clinic is available in surgical practice and is not accompanied by the occurrence of complications.