Self-limiting abdominal wall herniation and constipation following herpes zoster infection

Segmental Abdominal Paresis Attributed to Herpes Zoster Infection Mimicking an Abdominal Hernia: An Interesting Case From a Surgical Unit of a Tertiary Healthcare Center

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.

Complete recovery from segmental zoster paresis confirmed by magnetic resonance imaging: A case report

BACKGROUND

Segmental zoster paresis, depending on the affected area, can present with severe clinical manifestations and render patients unable to perform activities of daily living. Therefore, it is necessary to diagnose and treat such a condition rapidly. No studies have reported using magnetic resonance imaging (MRI) to identify clinical abnormalities associated with this condition or its complete recovery. This rare case report evaluated the changes in MRI findings before and after the patient's motor symptoms recovered.

CASE SUMMARY

A 79-year-old woman with a history of rheumatoid arthritis and psoriasis visited the hospital for skin rashes and pain in the C5-T2 segments. The diagnosis was herpes zoster infection, and treatment was initiated. However, motor weakness suddenly occurred 14 d after the initial symptom presentation. We confirmed abnormal findings in the nerves and muscles invaded by the shingles using electromyography and MRI. After 17 mo, the patient's symptoms had completely normalized, and MRI confirmed that there were no abnormalities.

CONCLUSION

MRI can be a useful diagnostic modality for segmental zoster paresis and patient evaluation during recovery from motor complications.

Segmental Zoster Paresis of Lower Thoracic Segment Presenting as Pseudohernia-A Report of Three Cases

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.

Intestinal pseudo-obstruction caused by herpes zoster: Case report and pathophysiology

Herpes zoster (HZ) infection occurs in approximately 10% to 30% of individuals. Visceral neuropathies secondary to HZ can cause cystitis and urinary retention. But colonic pseudo-obstruction can also occur. Peripheral neuropathy may reveal segmental motor paresis of either upper or lower limbs, the abdominal muscles or the diaphragm. We report the case of a 62-year-old male patient who presented with abdominal distention and cutaneous vesicular eruption on the left side of the abdominal wall. Plain X-rays and computed tomography scan showed distended small bowel. A diagnosis of intestinal pseudo-obstruction was made secondary to segmental paresis of the small intestine and visceral neuropathy. Conservative management was successful and the patient was discharged uneventfully. Intestinal pseudo-obstruction ought to be considered when dealing with non-obstructive (adynamic) conditions of the digestive tract associated with HZ infection; since early recognition may help to avoid unnecessary surgery.

Ogilvie syndrome and herpes zoster: case report and review of the literature

BACKGROUND

The very unusual association between herpes zoster and Ogilvie syndrome has received scant attention in the published literature.

OBJECTIVES

This review discusses the published experience since 1950 and attempts to increase clinical awareness about the co-existence of both conditions.

CASE REPORT

An 84-year-old male patient affected by herpes zoster presented with advanced acute colonic pseudo-obstruction and was successfully treated with colonic diversion.

DISCUSSION

Twenty published studies (1950-2008) of 28 patients in whom the two conditions co-existed are reviewed. The review included 22 male and 7 female patients (24%) aged 32-87 years (mean, 61 years). Significant co-morbidities were present in 45% of the patients. The majority of patients were observed and treated conservatively (83%). Two patients died (7%), both suffering from respiratory complications and malignancy.

CONCLUSION

Recognition of the combined syndrome may help to avoid unnecessary surgery. Laparotomy should be reserved as a last resort for when the obstruction cannot be successfully managed by endoscopy. A diverting colostomy can be used to monitor the blood supply and thus provide early warning for an impending abdominal catastrophe.

Abdominal wall protrusion following herpes zoster

We present the case of a 62-year-old woman with abdominal segmental paresis consequent to radiculopathy caused by zoster, which was confirmed by electroneuromyography. The paresis resolved completely within three months. Recognition of this complication caused by zoster, which is easily misdiagnosed as abdominal herniation, is important for diagnosing this self-limited condition and avoiding unnecessary procedures.

Abdominal-wall postherpetic pseudohernia

Herpes zoster affects 10-20% of the general population. Motor complications sometimes occur in the segments corresponding to the involved sensory dermatomes causing abdominal wall pseudohernias. We present a case of a 57-year-old woman with herpes zoster characteristical rash following T11-T12 right dermatomes. Ten days after dermatologic manifestations onset, she had developed a protrusion at the abdominal wall on the right flank. The electroneuromyography confirmed axonal motor commitment, and morphological defects were ruled out by ultrasonography. The bulge totally disappeared after 4 months of observation. Postherpetic pseudohernia must be suspected when a patient develops signs and symptoms of motor dysfunction that coincide with or follow a herpes zoster eruption resulting in abdominal-wall herniation. A review of the literature concerning these extremely exceptional sequelae of herpes zoster is presented.