1/22. 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 = physical examination, physical (Clic here for more details about this article) |
2/22. Handlebar hernia: ultrasonography-aided diagnosis.Traumatic hernia resulting from blunt impalement of the abdominal wall, known as "handlebar hernia," is seldom addressed in the surgical literature, with only 28 previously reported cases. We describe our experience with this rare traumatic hernia diagnosed by physical examination and confirmed by ultrasonography. Published reports suggest handlebar hernia's potential for serious underlying injury and the diagnostic importance of computed tomographic scanning. The case presented here demonstrates the value of bedside ultrasonography in diagnosis confirmation and surgical planning for this condition.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/22. Management of traumatic abdominal wall hernia.Traumatic abdominal wall hernia (TAWH) can occur after blunt trauma and can be classified into low- or high-energy injuries. Low energy injuries occur after impact on a small blunt object. High-energy injuries are sustained during motor vehicle accidents or automobile versus pedestrian accidents. We present six cases of high-energy TAWH cases that were treated at our trauma center. All patients presented with varying degrees of abdominal tenderness with either abdominal skin ecchymosis or abrasions, which made physical examination difficult. CT scan confirmed the hernia in each patient. All six patients had associated injuries that required open repair. The abdominal wall defects were repaired primarily. Three patients (50%) in our series developed a postoperative wound infection or abscess. review of the literature on low-energy TAWH shows no associated abdominal injuries. In conclusion distinction between low- and high-energy injury is imperative in the management of TAWH. Hernias following low-energy injuries can be repaired after local exploration through an incision overlying the defect. TAWHs following high-energy trauma should undergo exploratory laparotomy through a midline incision. The defect should be repaired primarily and prosthetics avoided because of the high incidence of postoperative infection.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/22. Ultrasonic evaluation of ventral hernias disguised as intra-abcominal neoplasms.Most cases of ventral hernias are easily diagnosed by palpation, but palpation is a subjective examination that may be difficult or even misleading, especially in obese patients. In cases of diagnostic uncertainty, ultrasonic examinations offer an objective means of distinguishing between a mass in the abdominal wall and one actually deep to the peritoneum. In addition, if such a mass is detected, these studies provide information that can characterize its physical nature.- - - - - - - - - - ranking = 0.048844795352359keywords = physical (Clic here for more details about this article) |
5/22. Handlebar hernia in children: two cases and review of the literature.Localised traumatic abdominal hernias are rare. Most such hernias are due to the direct impact of the handlebars of a bicycle or motorcycle, with 20 cases reported to date in the English language literature, 12 in children. We report two new cases of handlebar hernia, in children aged 6 and 10 years. In both cases, physical examination revealed an area of contusion and bruising in the lower abdomen. However, the muscle defect was detected during the first examination in only one of the patients, and not until several days later in the other patient. Abdominal ultrasonography proved useful for diagnosis in both patients. Early surgical correction is necessary to prevent possible complications. This type of hernia should be borne in mind when evaluating children who have suffered abdominal trauma in a bicycle accident.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/22. Laparoscopic repair of a spigelian hernia: a case report and literature review.BACKGROUND: We present a case in which laparoscopy was both diagnostic and therapeutic in a patient with a spigelian hernia. CASE REPORT: A 35-year-old man was referred to the general surgery Service for evaluation of right lower quadrant abdominal pain of approximately 6 months. The pain was not disabling but was a constant discomfort. The patient did not have any significant past medical or surgical history, and the physical examination was significant only for an area of focal tenderness in the right lower quadrant. Ultrasound and CT scans of the patient's abdomen were unremarkable. A laparoscopic exploration of the area revealed a defect in the area of semilunar and semicircular lines consistent with a spigelian hernia. The patient underwent a laparoscopic herniorrhaphy with placement of a polypropylene mesh. CONCLUSION: This case illustrates the role of laparoscopy in the diagnosis and treatment of spigelian hernias.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/22. Atypical Mondor's disease mimicking a strangulated Spigelian hernia in a patient with a deep venous obstruction. A case report.Mondor's disease is a rare entity characterised by thrombophlebitis of the subcutaneous veins of the anterolateral thoraco-abdominal wall. The condition is usually benign and self-limiting. We report on a case of an inguinal localization of the disease, occurring on a dilated superficial epigastric vein acting as a collateral pathway due to a left ilio-femoral venous obstruction. The patient was referred to our department with a diagnosis of strangulated Spigelian hernia. General physical examination and ultrasonographic studies ruled out a complicated abdominal hernia and the presence of malignant disorders. A diagnosis of inguinal Mondor's disease in association with a chronic deep venous obstruction of the left ilio-femoral venous axis was made. The patient was treated with conservative therapy. warfarin was promptly started in order to impede progression of the thrombotic process to the ipsilateral great saphenous vein. Though atypical Mondor's disease is usually a benign, self-limiting process, it can cause unusual clinical patterns that might give rise to clinical dilemmas for the surgeon.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/22. Abdominal musculature abnormalities as a cause of groin pain in athletes. Inguinal hernias and pubalgia.There has been increasing interest within the European sports medicine community regarding the etiology and treatment of groin pain in the athlete. groin pain is most commonly caused by musculotendinous strains of the adductors and other muscles crossing the hip joint, but may also be related to abdominal wall abnormalities. Cases may be termed "pubalgia" if physical examination does not reveal inguinal hernia and there is an absence of other etiology for groin pain. We present nine cases of patients who underwent herniorrhaphies for groin pain. Two patients had groin pain without evidence of a hernia preoperatively (pubalgia). In the remaining seven patients we determined the presence of a hernia by physical examination. At operation, eight patients were found to have inguinal hernias. One patient had no hernia but had partial avulsion of the internal oblique fibers from their insertion at the public tubercle. The average interval from operation to return to full activity was 11 weeks. All patients returned to full activity within 3 months of surgery. One patient had persistent symptoms of mild incisional tenderness, but otherwise there were no recurrences, complications, or persistence of symptoms. Abnormalities of the abdominal wall, including inguinal hernias and microscopic tears or avulsions of the internal oblique muscle, can be an overlooked source of groin pain in the athlete. Operative treatment of this condition with herniorrhaphy can return the athlete to his sport within 3 months.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
9/22. Handlebar hernia: diagnosis by abdominal computed tomography.Traumatic "handlebar" hernia, produced by impaction of a bicycle handlebar on the abdominal wall, is a rare entity. Presented is the case of a 7-year-old boy who sustained such a hernia, which contained an incarcerated loop of small bowel. The use of abdominal computed tomography to confirm the diagnosis before operative reduction of the hernia appears to be a safe and efficacious adjunct to physical examination.- - - - - - - - - - ranking = 0.048844795352359keywords = physical (Clic here for more details about this article) |
10/22. Computed tomography demonstration of inferior lumbar (Petit's) hernia.Inferior lumbar (Petit's) hernia is an uncommon condition resulting from a defect in the posterior abdominal wall. Such hernias may be difficult to diagnose on the basis of physical signs and symptoms. A case of unsuspected inferior lumbar hernia clearly demonstrated by computed tomography (CT) is presented. Computed tomography is useful in determining the size and contents of the hernia, permitting accurate diagnosis, and planning treatment.- - - - - - - - - - ranking = 0.048844795352359keywords = physical (Clic here for more details about this article) |
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