1/17. Handlebar hernia with intra-abdominal extraluminal air presenting as a novel form of traumatic abdominal wall hernia: report of a case.An 18-year-old male was admitted to our Emergency Department with a traumatic abdominal wall hernia (TAWH) of the left lower quadrant (LLQ) after suffering hypogastric blunt injury and urogenital lacerations in a motorcycle accident. Upright chest X-ray showed a small amount of right infradiaphragmatic free air, and a computed tomographic (CT) scan demonstrated an abdominal wall hernia. At surgery, no impairment was found in the digestive tract, and an abdominal herniorrhaphy was performed. It is suggested that the free air had passed through a connection between the scrotal laceration and the contralateral abdominal defect via the subcutaneous space and was palpated as emphysema. This is a new type of TAWH, which suggests that blunt abdominal trauma may result in negative pressure in the subcutaneous and peritoneal cavity, and this could reflect the pathophysiology of TAWH.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/17. Incisional hernia and fascial defect following laparoscopic surgery.Complications involving the abdominal wall, particularly incisional hernias, were not expected when laparoscopic procedures were first introduced. With the increasing number of laparoscopies in abdominal surgery, more incisional hernias are observed. The authors report 13 cases of umbilical incisional hernia, which occurred late after laparoscopic cholecystectomy, and one case of omental procidentia through a lateral port, which occurred early after laparoscopic hernia repair with the transabdominal preperitoneal technique. There are 4 men and 10 women (mean age, 59.8 years; range, 40-74 years). Between March 1991 and December 1997, a total of 1,287 patients underwent laparoscopic operations at the Surgical Department of the Gradenigo Hospital in Turin, italy. Incisional hernia incidence is 1%. risk factors, such as chronic bronchitis or weight increase, which give rise to endoabdominal pressure, are present in some cases. malnutrition may have a major role in many cases. calculi larger than 15 mm are also seen frequently. Postlaparoscopy incisional hernia is generally a minor complication--only once did its occurrence cause a strangulated hernia. All precautions, including fascial suturing, must be taken to reduce the 1% incidence of postoperative incisional hernias.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/17. Incisional hernia and fascial defect following laparoscopic surgery.Complications involving the abdominal wall, particularly incisional hernias, were not expected when laparoscopic procedures were first introduced. With the increasing number of laparoscopies in abdominal surgery, more incisional hernias are observed. The authors report 13 cases of umbilical incisional hernia, which occurred late after laparoscopic cholecystectomy, and one case of omental procidentia through a lateral port, which occurred early after laparoscopic hernia repair with the transabdominal preperitoneal technique. There are 4 men and 10 women (mean age, 59.8 years; range, 40-74 years). Between March 1991 and December 1997, a total of 1,287 patients underwent laparoscopic operations at the Surgical Department of the Gradenigo Hospital in Turin, italy. Incisional hernia incidence is 1%. risk factors, such as chronic bronchitis or weight increase, which give rise to endoabdominal pressure, are present in some cases. malnutrition may have a major role in many cases. calculi larger than 15 mm are also seen frequently. Postlaparoscopy incisional hernia is generally a minor complication--only once did its occurrence cause a strangulated hernia. All precautions, including fascial suturing, must be taken to reduce the 1% incidence of postoperative incisional hernias.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/17. Laparoscopic management of Spigelian hernia.Spigelian hernia (SH) is an uncommon abdominal wall hernia. Its clinical symptoms are not characteristic, and the preoperative diagnosis is often difficult because SH can simulate the symptoms of more classical lower quadrant abdominal diseases. We report a case of SH in an 80-year-old woman that was complicated by incarceration and diagnosed by physical examination and ultrasound. At the time of presentation, she had an abdominal mass that was soft and occasionally painful, and aggravated by movements that increase intraabdominal pressure. Laparoscopic examination of the abdominal cavity identified the incarcerate jejunum ansae. The defect was a large opening in the peritoneum along the lateral margin of the rectus abdominis muscle. After dissection of the intestinal adhesions, a prosthetic polypropylene mesh was introduced and fixed with staples into the lateral abdominal wall. There were no postoperative complications. We conclude that the laparoscopic approach is a feasible alternative to the conventional open technique that is easy, safe, and allows excellent operative visualization.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/17. Incarcerated Spigelian hernia following laparoscopic living-donor nephrectomy.We present the case of an incarcerated Spigelian hernia that manifested 24 hours after a laparoscopic living-donor nephrectomy. The differential diagnosis, proposed management, and a review of the literature is presented. Bowel obstruction occurring within a few days following laparoscopic surgery is most often attributed to a hernia at a trocar site. In the case of living-donor nephrectomy. the hernia could also occur at the incision made for removal of the kidney. Spigelian hernia has not been reported as a complication of laparoscopic surgery in the past and, therefore, would not normally be considered in the differential diagnosis of any complications following laparoscopic surgery. With the increasing use of laparoscopy, unsuspected intraabdominal conditions may be diagnosed during the procedure or become manifest because of increased intraabdominal pressure created by the pneumoperitoneum. Here we report the diagnosis and repair of a Spigelian hernia that became manifest 1 day after laparoscopic nephrectomy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/17. Spigelian hernia long considered as diverticulitis: CT scan diagnosis and laparoscopic treatment. Computed tomography.Spigelian hernia (SH) develops in the spigelian aponeurosis. In some cases, its clinical symptoms may mimic those infrequently the diagnosis of sigmoid diverticulitis. Herein we report the case of a patient who for 12 years experienced a pain and a mass in the left lower quadrant that appeared after straining and then disappeared again after rest. A diagnosis of sigmoid diverticulitis was made. She was admitted to hospital for the acute onset of an intense abdominal pain in the left lower quadrant associated with fever. Physical exam showed a 10 x 15 cm mass in the left lower quadrant. Computed tomography (CT) scan showed a left-sided SH containing a small bowel loop and a sigmoid loop. The SH was reduced easily with bed rest and external pressure. Under laparoscopy, a Gore-Tex mesh was stapled on the posterior side of the anterolateral abdominal wall so that it widely covered the abdominal wall defect. The reducible SH, the incarcerated SH, and the strangulated SH represent the majority of the clinical aspects of SH. Although many differential diagnoses are proposed, but the diagnosis of sigmoid diverticulitis is an infrequent one. Ultrasound (US) scan or a CT scan that shows the defect in the abdominal wall, the hernial sac, and its contents is an easy means of confirming the diagnosis of SH. SH can be treated through a direct approach or through a midline laparotomy. laparoscopy is advisable for a tension-free treatment with an intraperitoneal mesh. It is important to make the diagnosis of SH before its strangulation. For that reason, CT scan and US scan are highly recommended. Laparoscopic treatment, which is effective and safe, is advisable in such cases.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/17. hernia of the posterior lamina of the rectus abdominis muscle sheath: report of a case.A case of hernia of the posterior lamina of the rectus abdominis muscle sheath in a 30 years old female, six months pregnant, is reported. The symptomatology was almost exclusively characterized by a persistent abdominal pain, located in the right costal margin at the intersection with the right adsternal line and aggravated by changes in position and by increases of intra-abdominal pressure. No bulge or specific hernial defect was clinically appreciable. The key to diagnosis, in this case, was an echography of soft tissues performed in the area where the pain was greater: with the patient in orthostatic position, it was possible to demonstrate a defect in the posterior sheath of the rectus abdominis muscle, that, increasing the intra-abdominal pressure, let pass preperitoneal fat between sheath and muscle. Both the predisposing (anatomic and clinical) factors and the provocateurs ones, probably involved in the genesis of this peculiar case, are discussed.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
8/17. Ventral hernia with a skin-covered Silastic sheet for newborn infants with a diaphragmatic hernia.The persistently high mortality rate for newborn infants with a congenital diaphragmatic hernia, which is symptomatic and treated in the first 24 hours of life, is due to multiple pulmonary and vascular factors. This demands the exclusion of any additional compromising elements. The effects of increased intra-abdominal pressure due to replacement of the intestine into the abdomen can be avoided by the formation of a ventral hernia. A large hernia can be produced best by suturing a sheet of Dacron reinforced Silastic to the fascia of a midline abdominal incision and covering it with skin flaps. This nonreactive prosthesis will remain in place for several months and later can be removed simply. This technique was used successfully in three infants and should improve the survival rate of precariously balanced newborn infants operated upon during the first few hours of life.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/17. adult umbilical hernia with vertical dislocation.We present a case of adult umbilical hernia with vertical dislocation along the abdominal wall. The hernial sac arose from the internal ring and connected to the umbilicus 20 mm below the internal ring. The postoperative course was uneventful. Two years and four months after the operation there was no evidence of recurrent hernia even when abdominal pressure was increased, and the umbilicus looked acceptable. An umbilical hernia is usually within the umbilicus. The hernial sac arose from the internal ring so should be called an umbilical hernia not an epigastric hernia. It is unusual that the umbilical hernia dislocates vertically along the abdominal wall, while the umbilicus stays depressed. This atypical form of umbilical hernia has not been described previously as far as we know.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/17. Incisional hernia after periacetabular osteotomy.The incidence of incisional abdominal hernias, an unreported complication after a Bernese periacetabular osteotomy, was evaluated. Two cases of an incisional hernia above the iliac crest were detected in a series of 950 cases since 1984. Although the incidence has been small, risk factors may be obesity, weak abdominal muscle strength, or increased abdominal pressure attributable to chronic coughing or obstipation. The surgeon should recognize the importance of restoring continuity of the abdominal fascia in patients with such factors.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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