[Liver hernia. Prognosis and report of 11 cases]

Irreducible primary ventral abdominal hernia containing segment III of the liver: A case report

INTRODUCTION AND IMPORTANCE

Herniation of the liver through the anterior abdominal wall is extremely rare entity; majority of cases are from incisional hernia after upper abdominal or cardiac surgery.

CASE PRESENTATION

A 42-year-old woman who is known to have asthma presented to our emergency unit with, vomiting, epigastric pain, and swelling of 12 h duration. Upon examination, we found a mildly tender and irreducible epigastric abdominal swelling. Clinically, SBO (small bowel obstruction) secondary to irreducible epigastric hernia was suspected and abdominal ultrasound and non-contrast CT scan was done. Both ultrasound and CT revealed an epigastric hernia containing segment III of the liver. She underwent an emergent abdominal exploration that included non-anatomic resection of segment III of the liver and tissue-based hernia repair.

CLINICAL DISCUSSION

Primary anterior liver hernia is herniation of the liver through the anterior abdominal wall defect in the absence of a previous abdominal incision. Diagnosis requires imaging studies such as abdominal ultrasound and CT scan. The management depends on the patient presentation, if there is any complication like vascular compromise and injury to herniated liver.

CONCLUSION

Primary liver hernia through the anterior abdominal wall is extremely rare entity. To the best of our knowledge, only four cases of primary anterior liver hernia have been described in the literature.

Incarcerated primary anterior liver hernia: A case report

The anterior liver hernia is a very rare entity that mainly occurs within an incisional hernia. Primary anterior liver hernia, in the absence of a previous abdominal incision, is extremely rare. The diagnosis is suspected in patients with epigastric bulging. The confirmation requires imaging studies such as computed tomography scan (CT scan). We report the case of an incarcerated primary ventral liver hernia, in an 83-year-old man who presented with a sudden epigastric swelling. A contrast-enhanced CT scan confirmed the diagnosis of incarcerated epigastric hernia with liver and epiploic content. Risk factors were thought to be the increased intra-abdominal pressure related to benign prostate hyperplasia, as well as the old age of the patient. The surgical conservative management was successful.

[Strangulated hernia below the umbilicus containing the liver: a case report]

Herniation of liver segments through defects in the anterior abdominal wall is rare. To our knowledge, only three cases have been described in the literature. This study reports the case of a 84-year-old man presenting to the emergency department with strangulated hernia of the linea alba showing dullness to percussion with protrusion of a sensitive and firm mass. Laboratory test results were normal. Abdominal CT scan showed herniation of liver segment through the linea alba with calculous cholecystitis. The patient underwent retrograde cholecystectomy with subhepatic Redon drain and repair of the herniation by overlapping suture, associated with two subcutaneous vacuum suction Redon drains. The post-operative suite was simple and the patient was discharged on the second post-operative day. Six months after surgery, our patient was healthy. Herniation of liver segments through defects in the anterior abdominal wall is rare. Patients usually show little evidence if clinical signs. Abdominal CT scan is essential to assess the viability of parenchymal liver cells. Patients´ management is studied on a case-by-case basis, it can be surgical or non-surgical. Herniation of liver segments is rare; few cases have been reported in the literature and, in these cases, patients showed little evidence of clinical signs. CT scan is essential to assess the viability of parenchymal liver cells.

Ventral Primary Hernia with Liver Content

Background

Herniation of the liver through the anterior abdominal wall is an extremely rare phenomenon. Most cases occur within an incisional hernia (mostly upper abdomen surgery or cardiac surgery). Only two reports mentioned liver herniation without previous abdominal incision. Case Presentation. We report the case of a 70-year-old woman presenting an epigastric swelling. Radiological findings showed a liver herniation in a primary ventral hernia. This case is the first to have been described requiring semiurgent hernia repair associated with partial liver resection.

Conclusion

This case is, to the best of our knowledge, the first case of primary ventral hernia with liver content necessitating wedge resection of the left liver lobe.

Herniation of the liver via an incisional abdominal wall defect

Herniation of the liver through an anterior abdominal wall incisional defect has rarely been described. An 81-year-old man presented to our surgical team with acute right upper quadrant abdominal pain. He had undergone coronary artery bypass grafting via a median sternotomy 7 years previously. Examination revealed gallbladder tenderness and a non-tender incisional epigastric hernia. Cholecystitis was confirmed on ultrasound. A CT scan revealed a knuckle of liver (segment II/III) herniating through an upper midline anterior abdominal wall incisional defect.

Left hepatic lobe herniation through an incisional anterior abdominal wall hernia and right adrenal myelolipoma: a case report and review of the literature

Introduction

Herniation of the liver through an anterior abdominal wall hernia defect is rare. To the best of our knowledge, only three cases have been described in the literature.

Case presentation

A 70-year-old Mexican woman presented with a one-week history of right upper quadrant abdominal pain, nausea, vomiting, and jaundice to our Department of General Surgery. Her medical history included an open cholecystectomy from 20 years earlier and excessive weight. She presented with jaundice, abdominal distension with a midline surgical scar, right upper quadrant tenderness, and a large midline abdominal wall defect with dullness upon percussion and protrusion of a large, tender, and firm mass. The results of laboratory tests were suggestive of cholestasis. Ultrasound revealed choledocholithiasis. A computed tomography scan showed a protrusion of the left hepatic lobe through the anterior abdominal wall defect and a well-defined, soft tissue density lesion in the right adrenal topography. An endoscopic common bile duct stone extraction was unsuccessful. During surgery, the right adrenal tumor was resected first. The hernia was approached through a median supraumbilical incision; the totality of the left lobe was protruding through the abdominal wall defect, and once the lobe was reduced to its normal position, a common bile duct surgical exploration with multiple stone extraction was performed. Finally, the abdominal wall was reconstructed. Histopathology revealed an adrenal myelolipoma. Six months after the operation, our patient remains in good health.

Conclusions

The case of liver herniation through an incisional anterior abdominal wall hernia in this report represents, to the best of our knowledge, the fourth such case reported in the literature. The rarity of this medical entity makes it almost impossible to specifically describe predisposing risk factors for liver herniation. Obesity, the right adrenal myelolipoma mass effect, and the previous abdominal surgery are likely to have contributed to incisional hernia formation.