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Sukhija R, Sethy M, Srinivas CR, Jain K. Abdominal Pseudo Hernia: A Rare Complication of Herpes Zoster. Indian Dermatol Online J 2024; 15:681-682. [PMID: 39050065 PMCID: PMC11265753 DOI: 10.4103/idoj.idoj_523_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 07/27/2024] Open
Affiliation(s)
- Riya Sukhija
- Department of Dermatology Venereology and Leprosy, Kalinga Institute of Medical Sciences (KIMS), KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Mitanjali Sethy
- Department of Dermatology Venereology and Leprosy, Kalinga Institute of Medical Sciences (KIMS), KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Chakravarthy R. Srinivas
- Department of Dermatology Venereology and Leprosy, Kalinga Institute of Medical Sciences (KIMS), KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Kriti Jain
- Department of Dermatology Venereology and Leprosy, Kalinga Institute of Medical Sciences (KIMS), KIIT Deemed to be University, Bhubaneswar, Odisha, India
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Przygocka A, Magnoni G, Picotti M, Rapanà R, La Manna G. Rare case of postherpetic abdominal pseudohernia in a patient on peritoneal dialysis. J Nephrol 2024:10.1007/s40620-024-01954-3. [PMID: 38837002 DOI: 10.1007/s40620-024-01954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/06/2024] [Indexed: 06/06/2024]
Abstract
Patients affected by chronic kidney disease, especially those requiring maintenance dialysis therapy, are particularly susceptible to infections, including reactivation of herpes zoster and are also at increased risk of herpes zoster complications. Postherpetic abdominal pseudohernia is a rare sequela of the infection, caused by motor neuropathy with muscle paresis, that manifests as an abdominal protrusion. In patients receiving peritoneal dialysis who may often present slight abdominal distension, the diagnosis of this complication may be challenging. We present a case of this rare neurological complication in a patient on peritoneal dialysis and discuss its etiology and management. To the best of our knowledge, this is the first report of postherpetic abdominal pseudohernia in a patient receiving kidney replacement therapy.
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Affiliation(s)
- Agnieszka Przygocka
- Nephrology and Dialysis Unit, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Giacomo Magnoni
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matilde Picotti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Renato Rapanà
- Nephrology and Dialysis Unit, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy.
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Sharma A, Khanna R, Khanna S, Khanna R. Phantom Hernia: A Rare Sequela of Herpes Zoster Infection. Cureus 2024; 16:e63095. [PMID: 39055451 PMCID: PMC11270628 DOI: 10.7759/cureus.63095] [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: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
The herpes zoster (HZ) virus first manifests as varicella, or chickenpox, in children and remains dormant in the dorsal root ganglia of the nerves. The vesicular eruptions that might be painful develop along a dermatome when the virus is reactivated. While postherpetic neuralgia is a well-known side effect of herpes simplex, there are well-reported motor consequences as well. Segmental zoster paresis is an uncommon motor consequence of herpes zoster that resembles an anterior abdominal wall hernia but does not require surgery in contrast to an actual abdominal wall hernia. We present a similar case of a 46-year-old male who presented with classic herpes zoster rash and phantom hernia as a rare sequela of this condition.
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Affiliation(s)
- Aditya Sharma
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Ritika Khanna
- Department of Dermatology & Venereology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Seema Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Rahul Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
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Yagyu T, Yakami Y, Bando T. Acute gastric dilatation with segmented abdominal paresis as a rare manifestation of herpes zoster: a case report and review of the literature. J Med Case Rep 2024; 18:165. [PMID: 38584287 PMCID: PMC11000452 DOI: 10.1186/s13256-024-04487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/01/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Herpes zoster is a common disease that can affect men and women at any age. Sensory neuropathy is the most common complication while motor neuropathy of the abdominal muscles is rare complication appearing in ~ 0.7% of patients. Furthermore, visceral nerve involvement causing gastroparesis is an extremely rare postherpetic complication. We present an extremely rare case of acute gastric dilatation with segmented abdominal paresis as a rare manifestation of herpes zoster infection. CASE PRESENTATION A 91-year-old Asian man was admitted to hospital with 2-day history of vomiting and left abdominal protrusion. He was previously treated for a rash on the left abdominal wall as herpes zoster infection with oral valaciclovir 2 weeks prior. On physical examination, characteristic herpes zoster rash scars and an ipsilateral abdominal bulge were observed on the left side. Computed tomography revealed no abdominal wall defect, mass, or stenosis. Remarkable distension of the stomach, asymmetrical left flank wall bulge, and a thinner abdominal wall on the left compared with the right side were shown. He was diagnosed as acute gastric dilatation owing to gastroparesis and segmental paresis of the abdominal musculature associated with herpes zoster infection. The patient showed significant improvement in symptoms and abdominal paresis within a month of conservative treatment, including nasogastric tube decompression and mosapride administration. CONCLUSION Acute gastric dilatation with abdominal paresis is an extremely rare complication of herpes zoster infection, and to date there have been no reports in the literature. It alerts us that, when examining patients with abdominal bulge, we should be conscious of this rare pathology for the optical diagnosis, avoiding unnecessary invasive examination or surgical exploration.
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Affiliation(s)
- Toshihiko Yagyu
- Department of Gastroenterology, Higashi Osaka Hospital, 1-7-22, Chuo, Jyoto-Ku, Osaka, 536-0005, Japan.
| | - Yoshikazu Yakami
- Department of Gastroenterology, Higashi Osaka Hospital, 1-7-22, Chuo, Jyoto-Ku, Osaka, 536-0005, Japan
| | - Tomoki Bando
- Department of Gastroenterology, Higashi Osaka Hospital, 1-7-22, Chuo, Jyoto-Ku, Osaka, 536-0005, Japan
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Sharma A, Singh SK, Srivastava V, Pratap A, Ansari MA. Segmental Abdominal Paresis Attributed to Herpes Zoster Infection Mimicking an Abdominal Hernia: An Interesting Case From a Surgical Unit of a Tertiary Healthcare Center. Cureus 2024; 16:e51728. [PMID: 38318589 PMCID: PMC10839425 DOI: 10.7759/cureus.51728] [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: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
The varicella-zoster virus reactivates to cause herpes zoster, commonly referred to as shingles. Shingles traditionally manifest as itchy vesicles in a dermatomal distribution, accompanied by related constitutional symptoms in immunocompetent patients. Usually, the rash resolves completely in seven to ten days. Herpetic neuralgia is the most typical herpes zoster consequence. Around 1% to 5% of individuals have motor impairments, with Ramsay-Hunt syndrome being the most prevalent ailment. Additional problems encompass abdominal pseudohernia, paralytic ileus/colonic pseudo-obstruction, hemidiaphragm paralysis, bladder dysfunction, localized paresis, constipation, and visceral neuropathy. Herpes zoster infection typically involves the posterior root ganglia, and most of the symptoms are sensory. Motor involvement can occur in the same distribution but is relatively uncommon. Segmental zoster paresis is a rare motor complication of herpes zoster, mimicking an abdominal hernia, which has an incidence of approximately 0.7%, but it needs no surgery different from the real abdominal wall hernia. In this case report, we describe a patient who, three weeks after developing a herpes zoster rash, acquired an abdominal protrusion, i.e., herpes-induced pseudohernia.
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Affiliation(s)
- Aditya Sharma
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Satyendra K Singh
- Department of Dermatology & Venereology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Vivek Srivastava
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Arvind Pratap
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Mumtaz A Ansari
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
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Goto M, Ishizuka K, Ie K, Okuse C. Postherpetic abdominal pseudohernia. BMJ Case Rep 2023; 16:e257831. [PMID: 38056925 PMCID: PMC10711839 DOI: 10.1136/bcr-2023-257831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Affiliation(s)
- Miharu Goto
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan
| | - Kenya Ie
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Chiaki Okuse
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
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Morrell DJ, DeLong CG, Horne CM, Pauli EM. Radiographic identification of thoracoabdominal hernias. Hernia 2021; 26:287-295. [PMID: 34125302 DOI: 10.1007/s10029-021-02437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Hernias spanning both chest and abdominal walls are uncommon and associated with chest wall trauma, coughing and obesity. This study describes the radiographic appearance of these hernias to guide proper identification and operative planning. Proposed standardized reporting patterns are also presented. METHODS The cross sectional imaging of patients presenting with thoracoabdominal hernias was reviewed. Radiographic reports were supplemented by surgeon imaging review and operative findings during repair. Defect dimensions, hernia content, level of herniation, presence of osseous or cartilaginous disruption of the chest wall and degree of rib displacement were collected. Disruption of myofascial planes was also noted. RESULTS Six patients were identified. All hernias occurred below the 9th rib and were associated with complete intercostal muscle disruption. The transversus abdominis was disrupted in all hernias and the internal oblique was disrupted in five of the hernias. The majority (83%) had caudal rib displacement (median 6.8 cm compared to contralateral side). Median hernia width was 10.35 cm (1.6-19.1 cm) and median length was 10.2 cm (1.8-14.3 cm). Five patients had associated bone/cartilage injuries: two with 11th rib fractures, two with combined bone and cartilaginous fractures and one with a surgical rib resection. CONCLUSION The typical injury pattern of thoracoabdominal hernias includes disruption of the intercostal muscles, transversus abdominis, and commonly the internal oblique with an intact external oblique. Inferior rib displacement by hernia contents and unopposed pull of the abdominal musculature is common. Osseous or cartilaginous disruption always occurs unless the defect is bounded on at least one side by a floating rib.
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Affiliation(s)
- David J Morrell
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033-0850, USA
| | - Colin G DeLong
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033-0850, USA
| | - Charlotte M Horne
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033-0850, USA
| | - Eric M Pauli
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H149, Hershey, PA, 17033-0850, USA.
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Yeap E, Hodgkins B, Suhardja TS. Abdominal pseudohernia caused by herpes zoster motor neuropathy. ANZ J Surg 2021; 91:E769-E771. [PMID: 33885217 DOI: 10.1111/ans.16895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Evie Yeap
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Melbourne, Victoria, Australia
| | - Brian Hodgkins
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Melbourne, Victoria, Australia
| | - Thomas Surya Suhardja
- Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Melbourne, Victoria, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Choi MS, Jang MH, Lee BJ, Shin YB, Kim SH. A novel assessment of abdominal pseudohernia after thoracolumbar vertebral compression fractures using surface electromyography and ultrasonography: A case report. Medicine (Baltimore) 2021; 100:e24973. [PMID: 33655965 PMCID: PMC7939196 DOI: 10.1097/md.0000000000024973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/27/2021] [Accepted: 02/11/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE An abdominal pseudohernia is a protrusion of the abdominal wall that there is no actual muscular disruption. This report presents a case in which abdominal muscle activities were accurately and quantitatively measured using ultrasonography (US) and surface electromyography in a patient with abdominal pseudohernia. PATIENT CONCERNS A 62-year-old man presented with a marked protrusion on the left abdomen with increasing abdominal pressure. DIAGNOSES First, the thickness of the abdominal muscle was measured with US while the patient constantly blew the positive expiratory pressure device. When the force was applied to the abdomen, the mean thickness of the muscle layer on the lesion site was found to be thinner. Second, the activities of the abdominal muscles were measured using surface electromyography by attaching electrodes to 8 channels at the same time. When the same pressure was applied on both sides of the abdomen, more recruitment occurred to compensate for muscle weakness at the lesion site. Through the previous 2 tests, the decrease in muscle activity in the lesion area could be quantitatively evaluated. Third, the denervation of the muscle was confirmed using US-guided needle electromyography. INTERVENTIONS The patient in this case was wearing an abdominal binder. In addition, he had been training his abdominal muscles through McGill exercise and breathing exercises such as with a positive expiratory pressure device. OUTCOMES The patient was able to understand his symptoms. A follow-up test will be performed to see if there is any improvement. LESSONS By using these outstanding assessment methods, proper diagnosis and rehabilitation treatment strategies can be developed.
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Affiliation(s)
- Min Soo Choi
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital
| | - Myung Hun Jang
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital
| | - Byeong Ju Lee
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital and Pusan National University School of Medicine, Busan, Republic of Korea
| | - Sang Hun Kim
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital
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Shastry V, Ranugha PSS, Vinutha R, Pratheeksha S. Segmental Zoster Paresis of Lower Thoracic Segment Presenting as Pseudohernia-A Report of Three Cases. Indian Dermatol Online J 2021; 12:324-326. [PMID: 33959535 PMCID: PMC8088169 DOI: 10.4103/idoj.idoj_223_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/15/2020] [Accepted: 06/28/2020] [Indexed: 11/04/2022] Open
Abstract
Segmental zoster paresis is characterized by focal motor weakness affecting the myotome corresponding to the dermatomal distribution of the rash. Clinically, it presents as pseudohernia when it involves abdominal wall muscles. We report three cases of segmental zoster paresis presenting as pseudohernia of abdominal wall. All patients developed asymptomatic bulge in anterolateral side of abdomen between 10 and 15 days after appearance of vesicles. All patients developed post-herpetic neuralgia. One patient developed pseudo-obstruction of colon due to visceral involvement. Segmental zoster paresis of lower thoracic spinal segment often goes unnoticed due to its asymptomatic nature.
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Affiliation(s)
- Veeranna Shastry
- Department of Dermatology, Venereology and Leprosy, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - P S S Ranugha
- Department of Dermatology, Venereology and Leprosy, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - R Vinutha
- Department of Dermatology, Venereology and Leprosy, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - S Pratheeksha
- Department of Dermatology, Venereology and Leprosy, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
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Tan SM, Sek KS, Teng GG. Herpes Zoster-Associated Abdominal Pseudohernia. Am J Med 2021; 134:e119-e120. [PMID: 32835690 DOI: 10.1016/j.amjmed.2020.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Sandra My Tan
- Division of Advanced Internal Medicine, University Medicine Cluster, National University Hospital, National University Health System, Singapore.
| | - Kathleen Sy Sek
- Chronic Program, Alexandra Hospital, National University Health System, Singapore; Division of Endocrinology, University Medicine Cluster, National University Hospital, National University Health System, Singapore
| | - Gim Gee Teng
- Chronic Program, Alexandra Hospital, National University Health System, Singapore; Division of Rheumatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore
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Sharobaro VI, Ivanov YV, Sharobaro VI, Smirnov AV. [Abdominal pseudohernia: diagnosis and treatment]. Khirurgiia (Mosk) 2021:72-80. [PMID: 34941212 DOI: 10.17116/hirurgia202112172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To present an effective treatment strategy for abdominal pseudohernia considering own clinical experience and literature data. MATERIAL AND METHODS The authors report surgical treatment of 2 patients and therapeutic management of 1 patient with abdominal pseudohernia. Moreover, current state of this problem is analyzed according to literature data in Pubmed, Google and e-library databases. RESULTS. P Seudohernia is followed by asymmetrical protrusion of abdominal wall, prolapsed site is not involved in breathing; patients cannot tense muscles in the affected area. T8-L2 skin sensitivity impairment or hyperesthesia may be observed. Denervation is confirmed by electroneuromyography. Ultrasound, CT and MRI reveal no defect in abdominal wall. However, its thinning within denervation area is visualized. Treatment is determined by the cause and reversibility of denervation. If mechanical damage (intersection) of T8-L2 nerves following trauma or any manipulation is absent, the main cause is herpes zoster neuropathy. Surgical treatment is not indicated. Antiherpetic therapy and physical therapy result functional restoration of abdominal wall muscles within 2-4 months. In case of mechanical cause of pseudohernia, it is advisable to wait at least a year after denervation for real assessment of situation. Partial or complete re-innervation is possible throughout this period. Surgical treatment is indicated if re-innervation is absent. An effective technique presented in this manuscript is reconstruction of the prolapsed area with several imbrication sutures in several planes up to symmetry with contralateral area with subsequent reinforcement with a mesh implant if necessary. There were no relapses in 2 our patients within 5 and 7 years, respectively. CONCLUSION In our opinion, this report is the first manuscript devoted to systematic analysis of diagnosis and treatment of abdominal pseudohernia in available literature. Surgical treatment is not indicated for postherpetic pseudohernia. It is carried out for pseudohernia persisting for more than 1 year if its cause is trauma or any manipulation.
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Affiliation(s)
- V I Sharobaro
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Yu V Ivanov
- Federal Scientific and Clinical Center for Specialized Medical Care and Medical Technologies, Moscow, Russia
- Central Research Institute of Tuberculosis, Moscow, Russia
| | | | - A V Smirnov
- Federal Scientific and Clinical Center for Specialized Medical Care and Medical Technologies, Moscow, Russia
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Abstract
Post-herpetic abdominal pseudohernia is a neurologic complication of herpes zoster resulting from paresis of the abdominal wall muscles ipsilateral to the eruption. This poorly known condition may raise suspicion for true abdominal wall hernia or other concerning etiologies, resulting in extensive work-up and imaging. Post-herpetic abdominal pseudohernia is a relatively benign condition, which resolves spontaneously in the majority of cases. Therefore, it is important for the clinician to be aware of this complication in order to avoid unnecessary imaging or excessive management, which may increase the cost of care and burden to the patient.
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Affiliation(s)
| | | | - Sylvia Hsu
- Dermatology, Temple University Hospital, Philadelphia, USA
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Yasin J, Thimmappa N, Kaifi JT, Avella DM, Davis R, Tewari SO, Saboo SS, Bhat A. CT-guided cryoablation for post-thoracotomy pain syndrome: a retrospective analysis. ACTA ACUST UNITED AC 2020; 26:53-57. [PMID: 31904571 DOI: 10.5152/dir.2019.19179] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Post-thoracotomy pain syndrome is a common condition affecting up to 50% of post-thoracotomy patients. However, percutaneous computed tomography (CT)-guided intercostal nerve cryoablation may provide symptomatic benefit in chronic and/or refractory cases. METHODS A retrospective review of our institution's comprehensive case log from October 2017 to September 2018 for patients who underwent cryoablation was analyzed. Thirteen patients with post-thoracotomy pain syndrome, refractory to medical management, were treated with CT-guided intercostal nerve cryoablation. Most patients had treatment of the intercostal nerve at the level of their thoracotomy scar, two levels above and below. The safety and technical success of this technique and the clinical outcomes of the study population were then retrospectively reviewed. RESULTS Of the patients, 69% experienced significant improvement in their pain symptoms with a median pain improvement score of 3 points (range, -1 to 8 points) over a median follow-up of 11 months (range, 2-18.6 months). Complications included pneumothorax in 8% and pseudohernia in 23% of patients. CONCLUSION CT-guided intercostal nerve cryoablation may be an effective technique in the treatment of post-thoracotomy pain syndrome and requires further study.
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Affiliation(s)
- Junaid Yasin
- Department of Radiology, University of Missouri Columbia, One Hospital Drive, Columbia, United States;University of Missouri Columbia School of Medicine, One Hospital Drive, Columbia, United States
| | - Nanda Thimmappa
- Department of Radiology, University of Missouri Columbia, One Hospital Drive, Columbia, United States
| | - Jussuf T Kaifi
- Division for Cardiothoracic Surgery, University of Missouri Columbia, One Hospital Drive, Columbia, United States
| | - Diego M Avella
- Division for Cardiothoracic Surgery, University of Missouri Columbia, One Hospital Drive, Columbia, United States
| | - Ryan Davis
- Department of Radiology, University of Missouri Columbia, One Hospital Drive, Columbia, United States
| | - Sanjit O Tewari
- Department of Radiology, University of Missouri Columbia, One Hospital Drive, Columbia, United States
| | - Sachin S Saboo
- Department of Radiology, Division of Cardiothoracic Imaging, University of Texas Health Science Center, Texas, United States
| | - Ambarish Bhat
- Department of Radiology, University of Missouri Columbia, One Hospital Drive, Columbia, United States
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Setó-Torrent N, Iglesias-Sancho M, Arandes-Marcocci J, Salleras Redonnet M. Abdominal Pseudohernia Due to Herpes Zoster. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Setó-Torrent N, Iglesias-Sancho M, Arandes-Marcocci J, Salleras Redonnet M. Pseudohernia abdominal por herpes zóster. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:790-792. [DOI: 10.1016/j.ad.2019.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 10/23/2022] Open
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Affiliation(s)
- So Sakamoto
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | | | - Manabu Sugita
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
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Hori H, Fukuchi T, Sugawara H. At-a-glance diagnosis of postherpetic abdominal pseudohernia. Int J Infect Dis 2020; 95:371-372. [DOI: 10.1016/j.ijid.2020.03.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/29/2020] [Indexed: 12/16/2022] Open
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Azimi SZ, Firooz A. Postherpetic abdominal pseudohernia: An uncommon complication of herpes zoster. Dermatol Ther 2020; 33:e13530. [PMID: 32383299 DOI: 10.1111/dth.13530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 01/15/2023]
Abstract
Herpes zoster, a common inflammatory viral disease, results in several complications. Pain and sensory disorders are the main symptoms of herpes zoster. We reported a case of segmental abdominal zoster with progression to motor involvement and pseudohernia.
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Affiliation(s)
- Seyyede Zeinab Azimi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
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Ramirez-Salas JE, Benito-Orejas JI, Bauer M, Viveros-Díez P, Cifuentes-Navas VA, Duque-Holguera V. Manifestaciones clínicas del síndrome de Ramsay-Hunt en una serie de 20 casos. REVISTA ORL 2020. [DOI: 10.14201/orl.22750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y objetivo: la experiencia clínica nos ha mostrado las distintas formas de presentación y la variabilidad sintomatológica que puede revelar el síndrome de Ramsay-Hunt o herpes zóster ótico. Las descripciones que ofrece la literatura nos han servido para corroborar los hallazgos de un conjunto de pacientes, cuyas características y evolución hemos ido reuniendo en el tiempo. Dada la importancia del tratamiento precoz, el objetivo de este trabajo ha consistido en realizar una exposición estructurada de este complejo síndrome con sus diversas manifestaciones. Método: estudio retrospectivo. Resultados: 20 pacientes ejemplifican los diferentes aspectos de este proceso. Discusión: se trata de una patología infrecuente, con una tríada sintomática patognomónica que consiste en otalgia, erupción vesicular y parálisis facial. Sin embargo, este síndrome no siempre se expresa de forma completa ni con la aparición de los síntomas en el orden indicado, añadiéndose con frecuencia otros cocleovestibulares. La posibilidad de que la infección se propague de forma centrífuga y centrípeta facilita el que se afecten otros nervios sensitivos y motores, ocasionando una polineuropatía craneal (herpes zóster cefálico) y raquídea o incluso, con mucha menor frecuencia, la aparición de una meningoencefalitis. No conocemos con precisión los mecanismos por los que progresa este proceso ni los factores desencadenantes, aunque en ocasiones les haya predisponentes. Establecer un diagnóstico es fundamental para iniciar el tratamiento, cuya precocidad facilita la resolución del proceso. Conclusiones: siendo la sospecha clínica la principal herramienta de un diagnóstico precoz, nos ha parecido de interés realizar esta revisión, dada la infrecuencia del herpes zóster ótico.
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Riopelle A, Kim D, Dayal A. Spontaneous Resolution of Abdominal Pseudohernia After Herpes Zoster. Am J Med 2020; 133:e102-e103. [PMID: 31520626 DOI: 10.1016/j.amjmed.2019.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 08/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Daniel Kim
- Loyola University Chicago Stritch School of Medicine, Maywood, Ill
| | - Amit Dayal
- Loyola University Chicago Stritch School of Medicine, Maywood, Ill
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23
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Abdominal pseudohernia caused by herpes zoster: 3 case reports and a review of the literature. JAAD Case Rep 2019; 5:729-732. [PMID: 31440570 PMCID: PMC6698640 DOI: 10.1016/j.jdcr.2019.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Thakur V, Kumar S, Narang T. Postherpetic pseudohernia. Postgrad Med J 2019; 95:625. [PMID: 31326944 DOI: 10.1136/postgradmedj-2019-136927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Vishal Thakur
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sheetanshu Kumar
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Tirelli LL, Luna PC, Larralde M. Postherpetic abdominal pseudohernia. Presentation of a clinical case and literature review. Int J Dermatol 2019; 58:497-499. [PMID: 30020545 DOI: 10.1111/ijd.14146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/13/2018] [Accepted: 06/20/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Luciana L Tirelli
- Dermatology resident at Hospital Alemán, Service of Dermatology, Hospital Alemán, Buenos Aires, Argentina
| | - Paula C Luna
- Staff dermatologist at Hospital Alemán, Service of Dermatology, Hospital Alemán, Buenos Aires, Argentina
| | - Margarita Larralde
- Chief of Dermatology at Hospital Alemán, Service of Dermatology, Hospital Alemán, Buenos Aires, Argentina
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26
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Curell A, Ortega N, Protti GP, Balibrea JM, López-Cano M. Pseudohernia postherpética. Cir Esp 2019; 97:55-57. [DOI: 10.1016/j.ciresp.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/03/2018] [Indexed: 10/28/2022]
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27
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Lee JY, Sunwoo JS, Kwon KY, Lee KB, Ahn MY, Roh H. Postherpetic Pseudohernia: Lesion Localization using Thoracic Spine Magnetic Resonance Imaging. J Clin Neurol 2019; 15:262-264. [PMID: 30877702 PMCID: PMC6444150 DOI: 10.3988/jcn.2019.15.2.262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/25/2018] [Accepted: 11/28/2018] [Indexed: 12/05/2022] Open
Affiliation(s)
- Jeong-Yoon Lee
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul Hospital, Seoul, Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul Hospital, Seoul, Korea
| | - Kyum-Yil Kwon
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul Hospital, Seoul, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul Hospital, Seoul, Korea
| | - Moo-Young Ahn
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul Hospital, Seoul, Korea
| | - Hakjae Roh
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul Hospital, Seoul, Korea
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28
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Jeon Y, Lee H. Ramsay Hunt syndrome. J Dent Anesth Pain Med 2018; 18:333-337. [PMID: 30637343 PMCID: PMC6323042 DOI: 10.17245/jdapm.2018.18.6.333] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 12/22/2022] Open
Abstract
Ramsay Hunt syndrome is a type of acute herpes zoster, which occurs by reactivation of the varicella-zoster virus at the geniculate ganglion. Clinical presentation of Ramsay Hunt syndrome includes a vesicular rash on the ear (herpes zoster oticus) or in the oral mucosa accompanied by acute peripheral facial nerve paralysis. Other cranial nerves such as V, IX, XI, and XII are often involved. Additional variability of the clinical picture of Ramsay Hunt syndrome is produced by varying patterns of skin involvement explained by individual anastomoses between cranial and cervical nerves. Combination treatment containing anti-viral agents and steroids is recommended for the treatment of Ramsay Hunt syndrome. Additionally, early diagnosis of Ramsay Hunt syndrome is a crucial factor to improve damaged nerves in Ramsay Hunt syndrome, which initiates treatment as soon as possible.
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Affiliation(s)
- Younghoon Jeon
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - Heryim Lee
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
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Bárbara-Bataller E, Martín del Rosario F, Méndez-Suárez JL, Alemán-Sánchez C, Sosa Henríquez M. Seudohernia abdominal tras lesión medular. A propósito de 3 casos. Cir Esp 2018; 96:587-589. [DOI: 10.1016/j.ciresp.2018.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/19/2018] [Accepted: 02/25/2018] [Indexed: 01/12/2023]
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30
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Koshy E, Mengting L, Kumar H, Jianbo W. Epidemiology, treatment and prevention of herpes zoster: A comprehensive review. Indian J Dermatol Venereol Leprol 2018. [PMID: 29516900 DOI: 10.4103/ijdvl.ijdvl_1021_16] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Herpes zoster is a major health burden that can affect individuals of any age. It is seen more commonly among individuals aged ≥50 years, those with immunocompromised status, and those on immunosuppressant drugs. It is caused by a reactivation of varicella zoster virus infection. Cell-mediated immunity plays a role in this reactivation. Fever, pain, and itch are common symptoms before the onset of rash. Post-herpetic neuralgia is the most common complication associated with herpes zoster. Risk factors and complications associated with herpes zoster depend on the age, immune status, and the time of initializing treatment. Routine vaccination for individuals over 60 years has shown considerable effect in terms of reducing the incidence of herpes zoster and post-herpetic neuralgia. Treatment with antiviral drugs and analgesics within 72 hours of rash onset has been shown to reduce severity and complications associated with herpes zoster and post-herpetic neuralgia. This study mainly focuses on herpes zoster using articles and reviews from PubMed, Embase, Cochrane library, and a manual search from Google Scholar. We cover the incidence of herpes zoster, gender distribution, seasonal and regional distribution of herpes zoster, incidence of herpes zoster among immunocompromised individuals, incidence of post-herpetic neuralgia following a zoster infection, complications, management, and prevention of herpes zoster and post-herpetic neuralgia.
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Affiliation(s)
- Elsam Koshy
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lu Mengting
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hanasha Kumar
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wu Jianbo
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Miranda-Merchak A, García N, Vallejo R, Varela C. MRI findings of postherpetic abdominal wall pseudohernia: A case report. Clin Imaging 2018; 50:109-112. [DOI: 10.1016/j.clinimag.2018.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/26/2017] [Accepted: 01/08/2018] [Indexed: 01/13/2023]
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32
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Lee JH, Heo HJ, Kim I, Shin SI. Abdominal muscle paresis due to herpes zoster with hiatal hernia - A case report -. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.2.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Ji-Hye Lee
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Hyun-joo Heo
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Ikthae Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Sung In Shin
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
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33
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Paraspinal muscle involvement in herpes zoster-induced abdominal wall pseudohernia revealed by electrophysiological and radiological studies. J Neurol Sci 2018; 385:89-91. [DOI: 10.1016/j.jns.2017.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 12/07/2017] [Accepted: 12/18/2017] [Indexed: 12/24/2022]
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35
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Yagi Y, Matono T, Nakamura K, Imura H. Postherpetic abdominal pseudohernia: A diagnostic pitfall. J Gen Fam Med 2017; 19:36-37. [PMID: 29340267 PMCID: PMC5763025 DOI: 10.1002/jgf2.147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/05/2017] [Indexed: 12/12/2022] Open
Abstract
The accurate diagnosis of postherpetic abdominal pseudohernia, the rare complication of herpes zoster, is essential to avoid unnecessary imaging studies or surgery. Close observation and waiting for complete recovery are warranted considering the disease's self‐resolving nature and favorable prognosis.
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Affiliation(s)
- Yu Yagi
- Department of General Internal Medicine Iizuka Hospital Fukuoka Japan
| | - Takashi Matono
- Department of General Internal Medicine Iizuka Hospital Fukuoka Japan
| | - Kenichi Nakamura
- Department of General Internal Medicine Iizuka Hospital Fukuoka Japan
| | - Hiroshi Imura
- Department of General Internal Medicine Iizuka Hospital Fukuoka Japan
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Kim SY, Kim DG, Park YM, Jeon YH. Psoas compartment block for treatment of motor weakness and pain following herpes zoster. Korean J Pain 2017; 30:62-65. [PMID: 28119773 PMCID: PMC5256265 DOI: 10.3344/kjp.2017.30.1.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/05/2016] [Accepted: 08/22/2016] [Indexed: 12/14/2022] Open
Abstract
Reactivation of the latent varicella zoster virus in the sensory ganglion causes herpes zoster (HZ). Its characteristic symptom is a painful rash in the involved dermatome. HZ-induced motor weakness is rare and is usually resolved within one year of the onset, but some patients permanently experience motor dysfunction. Epidural steroid administration, with antiviral therapy, can be effective in treating pain from HZ and preventing postherpetic neuralgia. But an epidural block is contraindicated in patients receiving thromboprophylaxis. A psoas compartment block (PCB) provides equivalent analgesic efficacy with significantly low incidence of complication, compared to an epidural block. A 68 year old male patient recieving thromboprophylaxis presented with motor weakness following painful rash in his left L4 dermatome. Ten days before presentation, herpetic rash occurred on his left leg. We performed PCB with a steroid and local anesthetic, which successfully and safely alleviated the pain and motor weakness from HZ.
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Affiliation(s)
- Sae Young Kim
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Dong Gyeong Kim
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yong Min Park
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Young Hoon Jeon
- School of Dentistry, Kyungpook National University, Daegu, Korea
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37
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Butensky AM, Gruss LP, Gleit ZL. Flank pseudohernia following posterior rib fracture: a case report. J Med Case Rep 2016; 10:273. [PMID: 27716425 PMCID: PMC5045639 DOI: 10.1186/s13256-016-1054-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/05/2016] [Indexed: 11/29/2022] Open
Abstract
Background A pseudohernia is an abdominal wall bulge that may be mistaken for a hernia but that lacks the disruption of the abdominal wall that characterizes a hernia. Thus, the natural history and treatment of this condition differ from those of a hernia. This is the first report of a pseudohernia due to cough-associated rib fracture. Case presentation A case of pseudohernia due to fractures of the 10th and 11th ribs in a 68-year-old white woman is presented. The patient suffered from a major coughing episode 1 year prior to her presentation, after which she noted a progressively enlarging bulge in her left flank. Computed tomography demonstrated a bulge in the abdominal wall containing bowel and spleen but with all muscle and fascial layers intact; in addition, lateral 10th rib and posterior 11th rib fractures were noted. Conclusions As there was no defect in muscle or fascia, we diagnosed a pseudohernia, likely due to a denervation injury from the fractured ribs. Symptomatic treatment was recommended, including wearing a corset and referral to a pain management clinic. Symptomatic treatment is thought to be the mainstay of therapy for pseudohernias, as surgical intervention is unlikely to be of benefit.
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Affiliation(s)
- Adam M Butensky
- Columbia University College of Physicians and Surgeons, 5141 Broadway, Suite 3-170, New York, NY, 10034, USA
| | - Leah P Gruss
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Zachary L Gleit
- Department of Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, Suite 3-170, New York, NY, 10034, USA.
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Ohno S, Togawa Y, Chiku T, Sano W. Postherpetic pseudohernia: delayed onset of paresis of abdominal muscles due to herpes zoster causing an ipsilateral abdominal bulge. BMJ Case Rep 2016; 2016:bcr-2016-215377. [PMID: 27229900 PMCID: PMC4885417 DOI: 10.1136/bcr-2016-215377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Postherpetic pseudohernia causes an abdominal bulge as well as an abdominal wall herniation. This disease is one of the neurological complications of herpes zoster and essentially consists of paresis of ipsilateral abdominal muscles. Postherpetic pseudohernia may be mistaken for abdominal wall herniation because it is not well known. We describe two cases presenting an abdominal bulge. The ipsilateral abdominal bulge appeared after recovery from abdominal zoster. Abdominal CT showed no evidence of a herniation or mass. We diagnosed a postherpetic pseudohernia. One of the patients recovered spontaneously 4 months after the onset, and the other partially recovered after 2 months. This disease can be expected to disappear spontaneously, unlike abdominal herniation requiring surgery. It has been reported that 79.3% of patients eventually recovered spontaneously. For surgeons and general practitioners, it is beneficial to keep this disease in mind when examining a patient presenting an abdominal bulge.
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Affiliation(s)
| | | | - Tsuyoshi Chiku
- Department of Surgery, Kamitsuga Sogo Byoin, Kanuma, Japan
| | - Wataru Sano
- Department of Surgery, Kamitsuga Sogo Byoin, Kanuma, Japan
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Jeon YH. Herpes Zoster and Postherpetic Neuralgia: Practical Consideration for Prevention and Treatment. Korean J Pain 2015; 28:177-84. [PMID: 26175877 PMCID: PMC4500781 DOI: 10.3344/kjp.2015.28.3.177] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 05/23/2015] [Accepted: 05/26/2015] [Indexed: 12/14/2022] Open
Abstract
Herpes zoster (HZ) is a transient disease caused by the reactivation of latent varicella zoster virus (VZV) in spinal or cranial sensory ganglia. It is characterized by a painful rash in the affected dermatome. Postherpetic neuralgia (PHN) is the most troublesome side effect associated with HZ. However, PHN is often resistant to current analgesic treatments such as antidepressants, anticonvulsants, opioids, and topical agents including lidocaine patches and capsaicin cream and can persist for several years. The risk factors for reactivation of HZ include advanced age and compromised cell-mediated immunity (CMI). Early diagnosis and treatment with antiviral agents plus intervention treatments is believed to shorten the duration and severity of acute HZ and reduce the risk of PHN. Prophylactic vaccination against VZV can be the best option to prevent or reduce the incidence of HZ and PHN. This review focuses on the pathophysiology, clinical features, and management of HZ and PHN, as well as the efficacy of the HZ vaccine.
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Affiliation(s)
- Young Hoon Jeon
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Korea
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40
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Affiliation(s)
- Anastasia Yi
- Department of Physical Medicine and Rehabilitation, West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
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Segmental zoster abdominal paresis/paralysis, zoster pseudohernia or zoster lumbar hernia? Hernia 2013; 18:145-6. [PMID: 24166694 DOI: 10.1007/s10029-013-1175-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 10/19/2013] [Indexed: 01/16/2023]
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