Rare Abdominal Wall Defect Research Articles

Congenital hernia of umbilical cord with patent vitellointestinal duct along with evisceration of gut\u2014a rare presentation and unusual management

BackgroundCongenital hernia of umbilical cord is a rare congenital anomaly. Due to its presentation as herniation of small bowel or other viscera into the umbilical cord, it is often misdiagnosed as omphalocele minor.Case presentationWe are reporting a rare case of congenital hernia of umbilical cord which presented with rupture of hernia sac and evisceration of small bowel loops with reverse ileal intussusception via a patent vitellointestinal duct. It was managed by first repositioning the gut with stoma at umbilical site as a temporizing measure followed by definitive surgery in the form of resection of patent vitellointestinal duct and end to end ileal anastomosis.ConclusionCongenital hernia of umbilical cord with patent vitellointestinal duct is a rare abdominal wall defect which can present beyond neonatal period with evisceration of gut. A high index of suspicion should be kept by the first attending clinician to avoid a delay in management.

Laparoscopic Repair of Lumbar Hernia: A Case Report and Mini Review

Lumbar hernias are quite rare, constituting 2% of all abdominal wall hernias, and they are usually secondary to trauma or previous surgery. Approximately 300 cases have been reported so far. There are two different types, depending on the location: superior lumbar or Grynfeltt’s hernia and inferior or Petit’s hernia. Abdominal computed tomography (CT) will provide accurate diagnosis. Laparoscopic repair with mesh is the treatment of choice, especially when the hernia is symptomatic. We describe the diagnosis and laparoscopic repair of a symptomatic right superior lumbar hernia in a female patient, with a review of the relevant literature. The patient provided her written consent for publication of the case and the photographs. A 48-year-old female was referred to the surgical clinic with a symptomatic right sided abdominal hernia. Clinical examination revealed an abdominal wall defect in the right superior lumbar region. Abdominal CT confirmed a right Grynfeltt’s hernia, containing ascending colon and fat, but with no signs of strangulation. She underwent laparoscopic lumbar hernia repair with mesh under general anaesthesia, with uneventful recovery. Lumbar hernia is a rare abdominal wall defect, which is usually secondary to trauma or previous surgery. A thorough history and clinical examination, along with abdominal CT, will provide accurate confirmation of the diagnosis. CT should always be included in the investigation prior to surgery, even in uncomplicated cases. The relevant literature is limited, but confirms that laparoscopic repair with mesh is the treatment of choice, especially when the hernia is symptomatic.

Spigelian hernia - an unusual abdominal hernia: a case report and review of literature

Spigelian hernias are rare abdominal wall defects that occur at the semilunar line lateral to the rectus abdominis muscle. They are situated between the muscular layers of the abdominal wall and can be easily overlooked because of abdominal obesity. Generally difficult to diagnose because of their location and vague non-specific symptoms radiographic studies have been beneficial in confirming the diagnosis. The diagnosis has been considerably aided by the introduction of ultrasonography and Computed Tomography (CT). Once the diagnosis is made operative management is indicated due to chances of incarceration. We report a 48 years old patient from the IMS and SUM hospital, Bhubaneswar, Odisha, India who presented with colicky lower abdominal pain associated with a non-tender swelling above and lateral to the left inguinal canal. A diagnosis of Spigelian hernia was made and confirmed on exploration. The hernia was reduced and the defect repaired. His recovery was uneventful.

Single-incision laparoscopic total extraperitoneal repair for a Grynfeltt hernia: a case report

IntroductionA superior lumbar hernia, which is also known as a Grynfeltt hernia, is a rare abdominal wall defect that can be primary or secondary to trauma or orthopedic surgery. The anatomic location of a lumbar hernia makes diagnosis and repair challenging. We successfully repaired a lumbar hernia using a single-incision laparoscopic total extraperitoneal approach. To the best of our knowledge, this is the first report of the use of this surgical technique in the treatment of a primary Grynfeltt hernia.Case presentationA 76-year-old Taiwanese man presented to our hospital with a left lower bulging mass noted for over three months. Abdominal computed tomography revealed a left Grynfeltt hernia. We performed a single-incision laparoscopic total extraperitoneal repair. Our patient was discharged uneventfully on the fourth day after the operation. There was no evidence of recurrence after six months of follow-up.ConclusionA laparoscopic total extraperitoneal repair for a lumbar hernia provides an excellent operative view and minimal invasiveness. The single-incision technique also provides better cosmetic outcomes. Our experience suggests that the single-incision laparoscopic total extraperitoneal approach may be a feasible and safe alterative to conventional approaches in lumbar hernia repair.

Grynfelt hernia: case report and literature review

Back lumbar hernia is a rare abdominal wall defect that usually presents spontaneously after trauma or lumbar surgery or, less frequently, during infancy (congenital). Few reports have been published in the literature describing primary lumbar hernia. A general surgeon will have the opportunity to repair only one or a few lumbar hernia cases in his/her lifetime. We report a case of a healthy 50-year-old man, with no previous surgeries or history of trauma, who presented to the outpatient department with abdominal discomfort, pain, and a sensation of a growing mass on his lower left back for 4years. CT scan of the abdomen showed a mass in the left posterolateral abdominal wall. Specifically, a herniation of retroperitoneal fat between the erector spinae muscle group and internal oblique muscles through aponeurosis of the transversalis muscle (Grynfeltt hernia). The patient underwent a small lumbotomy, polypropylene mesh was placed and he recovered well. Although many techniques have been described for the surgical management of such hernias, none of them can be recommended as the preferred method. Our impression, however, is that the open approach, with a small lumbotomy, seems to be easy, safe and presents good postoperative recovery.

Spigelian Hernia as a Cause of Small Bowel Obstruction

Spigelian hernia is a rare abdominal wall defect usually appearing between the abdominal muscle lateral to the rectus abdominis and through a debilitated spigelian aponeurosis. Spigelian hernias account for 0.12% to 2.4% of all abdominal wall hernias with a 17-24% risk of strangulation. We report the case of a 77-year-old male that presented with small bowel obstruction with incarcerated spigelian hernia which was successfully treated with a Ventralex hernia patch (Bard Access Systems, Inc., Murray Hill, NJ). A small open incision over the incarcerated hernia was a safe and effective method of repairing an incarcerated spigelian hernia in an urgent fashion.

Lumbar hernia misdiagnosed as a subcutaneous lipoma: a case report

IntroductionLumbar hernia is a rare abdominal wall defect and clinical suspicion is necessary for diagnosis.Case presentationWe report the case of a 40-year-old Caucasian woman with a superior lumbar hernia (Grynfeltt hernia) initially misdiagnosed as a recurrent lipoma. The correct diagnosis was made intra-operatively and the hernia was repaired using synthetic mesh. The patient was free of recurrence at 4 months after the operation.ConclusionA lumbar or flank mass should always raise suspicion of a lumbar hernia. Ultrasound and computed tomography may confirm the diagnosis. Adequate surgical treatment should be planned on the basis of etiology and hernia size. Both open and laparoscopic techniques can be used with good results.

Mutational analysis of the BMP-1 gene in patients with gastroschisis

Background: Gastroschisis is a rare abdominal wall defect. Although the pathogenesis of gastroschisis is unknown, there is some evidence of the genetic etiology of gastroschisis. Recently, a functionally null deletion of the mouse bone morphogenic protein-1 (BMP-1) gene resulted in a phenotype that resembled a human neonate with gastroschisis. BMP-1 thus became the first potential candidate gene for gastroschisis. Methods: To explore this possibility the authors collected blood samples from 11 patients who had gastroschisis. Mutational analysis of exons 2 to 15 of the human BMP-1 gene was performed using genomic polymerase chain reaction, single-strand conformation polymorphism analysis and direct sequencing methods. Results: No mutation of the human BMP-1 gene was observed in any of these patients. Conclusion: Although heterogeneous etiologies might be proposed for gastroschisis, our results provide further evidence of a nongenetic etiology for gastroschisis. J Pediatr Surg 36:885-887. Copyright © 2001 by W.B. Saunders Company.