1
|
Slater KN, Doulaye M, Obodo U, George A, Mohammadbhoy A. A Case of an Atraumatic Posterior Perirenal Lumbar Hernia. Cureus 2023; 15:e33793. [PMID: 36819320 PMCID: PMC9927798 DOI: 10.7759/cureus.33793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/16/2023] Open
Abstract
Retroperitoneal lumbar hernias are a rare entity. Atraumatic posterior perirenal hernias are an exceptionally rare form of retroperitoneal lumbar hernias. Because of their infrequency, there are no standardized methods of surgical care for the treatment of atraumatic (primary spontaneous) posterior perirenal hernias. This report documents the finding and management of an atraumatic posterior perirenal lumbar hernia in a 69-year-old female.
Collapse
Affiliation(s)
- Kristin N Slater
- Dermatology, Lincoln Memorial University DeBusk College of Osteopathic Medicine, Harrogate, USA
| | | | - Uzoamaka Obodo
- Internal Medicine, Lincoln Memorial University DeBusk College of Osteopathic Medicine, Harrogate, USA
| | - Ann George
- Internal Medicine, Lincoln Memorial University DeBusk College of Osteopathic Medicine, Harrogate, USA
| | | |
Collapse
|
2
|
Gioco R, Sanfilippo C, Veroux P, Corona D, Privitera F, Brolese A, Ciarleglio F, Volpicelli A, Veroux M. Abdominal wall complications after kidney transplantation: A clinical review. Clin Transplant 2021; 35:e14506. [PMID: 34634148 PMCID: PMC9285099 DOI: 10.1111/ctr.14506] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 12/16/2022]
Abstract
Introduction Abdominal wall complications are common after kidney transplantation, and although they have a minor impact on patient and graft survival, they increase the patient's morbidity and may have an impact on quality of life. Abdominal wall complications have an overall incidence of 7.7–21%. Methods This review will explore the natural history of abdominal wall complications in the kidney transplant setting, with a special focus on wound dehiscence and incisional herni, with a particular emphasis on risk factors, clinical characteristics, and treatment. Results Many patient‐related risk factors have been suggested, including older age, obesity, and smoking, but kidney transplant recipients have an additional risk related to the use of immunosuppression. Wound dehiscence usually does not require surgical intervention. However, for deep dehiscence involving the fascial layer with concomitant infection, surgical treatment and/or negative pressure wound therapy may be required. Conclusions Incisional hernia (IH) may affect 1.1–18% of kidney transplant recipients. Most patients require surgical treatment, either open or laparoscopic. Mesh repair is considered the gold standard for the treatment of IH, since it is associated with a low rate of postoperative complications and an acceptable rate of recurrence. Biologic mesh could be an attractive alternative in patients with graft exposition or infection.
Collapse
Affiliation(s)
- Rossella Gioco
- General Surgery Unit, University Hospital of Catania, Catania, Italy
| | | | | | - Daniela Corona
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | | | | | | | - Massimiliano Veroux
- General Surgery Unit, University Hospital of Catania, Catania, Italy.,Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| |
Collapse
|
3
|
Garmpis N, Spartalis E, Schizas D, Patsouras D, Damaskos C, Spartalis M, Garmpi A, Nikiteas NI, Dimitroulis D. Incisional Hernias Post Liver Transplantation: Current Evidence of Epidemiology, Risk Factors and Laparoscopic Versus Open Repair. A Review of the Literature. In Vivo 2019; 33:1059-1066. [PMID: 31280193 DOI: 10.21873/invivo.11574] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIM The occurrence of an incisional hernia after liver transplantation consists of a potential complication that may seriously affect the postoperative course and the quality of patient's life in general. The purpose of this study was to report the current epidemiological data, analyze the risk factors, evaluate the role of laparoscopic repair in this condition, and present the technical difficulties in the management of this special patient group. MATERIALS AND METHODS A literature search was performed through PubMed. Our criteria included all studies published from March 1982 to February 2019 in English, regarding incisional post-transplant hernias and open or laparoscopic repair. Finally, we collected 19 relevant studies. RESULTS Incisional hernia may occur independently of the type of abdominal incision. Risk factors are both patient- and technique-related. CONCLUSION Well-organized randomized controlled studies are needed, in order to estimate the best treatment strategy for these patients.
Collapse
Affiliation(s)
- Nikolaos Garmpis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece .,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| | - Eleftherios Spartalis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Schizas
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,First Department of Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Patsouras
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Christos Damaskos
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Spartalis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Anna Garmpi
- Internal Medicine Department, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos I Nikiteas
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| |
Collapse
|
4
|
Anderson B, Merani S, Maskin A. Double Obstruction Following Third Renal Transplant: A Case Report. Transplant Proc 2019; 51:3080-3083. [PMID: 31627919 DOI: 10.1016/j.transproceed.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 06/24/2019] [Indexed: 11/17/2022]
Abstract
As the field of transplant evolves and patients with chronic disease live longer, retransplant for end-stage renal disease becomes more common because kidney allografts have a limited lifespan. In renal retransplant, graft and patient survival is near equivalent to first-time transplant; however, these procedures present a unique surgical risk profile, especially third and subsequent transplants, which are reviewed in this manuscript. The risk of bowel obstruction in primary kidney transplant recipients is much lower than patients who have undergone laparotomy for second or third transplant because of the retroperitoneal location of the transplanted kidney. Internal hernia is an uncommon cause of small bowel obstruction, particularly after kidney transplant, and often diagnosis and intervention are delayed because of diagnostic uncertainty. We report a case of a 34-year-old man with acute kidney injury and bowel obstruction, whose final diagnosis was an internal hernia around the transplanted ureter of an intra-abdominally placed third renal transplant resulting in ureteric obstruction associated with small bowel obstruction-a case of double obstruction.
Collapse
Affiliation(s)
- Blaire Anderson
- Division of Transplantation Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States.
| | - Shaheed Merani
- Division of Transplantation Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Alexander Maskin
- Division of Transplantation Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States
| |
Collapse
|
5
|
Moris D, Tsilimigras DI, Yerokun B, Seymour KA, Guerron AD, Fong PA, Spartalis E, Sudan R. Foramen of Winslow Hernia: a Review of the Literature Highlighting the Role of Laparoscopy. J Gastrointest Surg 2019; 23:2093-2099. [PMID: 31420858 DOI: 10.1007/s11605-019-04353-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 07/29/2019] [Indexed: 01/31/2023]
Abstract
Foramen of Winslow hernia (FWH) is an extremely rare entity accounting for up to 8% of internal hernias and 0.08% of all hernias. Only 150 cases of FWH have been described in the literature to date with a peak incidence between the third and sixth decades of life. Three main mechanisms seem to be implicated in the FWH pathogenesis: (a) excessive viscera mobility, (b) abnormal enlargement of the foramen of Winslow, and (c) changes in the intra-abdominal pressure. The presence of an abnormally long bowel, enlargement of the right liver lobe or cholecystectomy, a "wandering cecum," and defects of the gastrohepatic ligaments are some reported predisposing factors. Timely diagnosis through computed tomography facilitates the appropriate treatment before complications are evident. Although open repair has been mostly utilized, recently laparoscopic approach seems to gain ground due to the encouraging preliminary results. To date, the debate continues as to whether prophylactic measures to prevent recurrence of the FWH need to be undertaken: closure of the foramen, fixation of the highly mobilized viscera, or both.
Collapse
Affiliation(s)
| | - Diamantis I Tsilimigras
- Laboratory of Experimental Surgery and Surgical Research, Medical School, University of Athens, Athens, Greece
| | | | | | | | - Philip A Fong
- Department of Surgery, Duke University, Durham, NC, USA
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, Medical School, University of Athens, Athens, Greece
| | - Ranjan Sudan
- Department of Surgery, Duke University, Durham, NC, USA.
| |
Collapse
|