Laparoscopic repair of paediatric traumatic Spigelian hernia avoids the need for mesh

Traumatic Abdominal Wall Hernia in Children: A Systematic Review

BACKGROUND

Traumatic abdominal wall hernia (TAWH) in children is an uncommon injury and most commonly occurs after blunt abdominal trauma. There is no consensus on the management of these rare cases. We performed a systematic review of the literature to describe injuries, management, and outcomes.

MATERIALS AND METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, a systematic literature search of PubMed, Web of Science, Embase, and Google Scholar was performed to identify English-language publications of blunt TAWH in patients <18 y old. Conflicts were resolved by consensus. Data were collected on demographics, associated injuries, management, and outcomes.

RESULTS

A total of 71 articles were reviewed with 100 cases of TAWH. A total of 82.5% of patients were male, and the median age was 9 y old (range 2-15). Injury by bicycle handlebars was most common (72%) followed by motor vehicle collision (14%). Forty patients had intraabdominal injuries, most commonly bowel (70%) or mesentery (37.5%). Rate of intraabdominal injury was significantly higher in patients with injuries due to nonbicycle handlebar injuries when compared with bicycle handlebar injuries (60.7% versus 33.3%, P = 0.02). Most patients were managed operatively (85%), most commonly via laparotomy (68/85, 80%), with six laparoscopic repairs and five laparoscopic converted to open repairs. There were three reported complications and no recurrences over a median of follow-up of 5 mo in patients who underwent repair.

CONCLUSIONS

Pediatric TAWH is a rare injury with a high rate of intraabdominal injuries, particularly when due to high-impact mechanisms such as motor vehicle collision. Although open repair is more commonly performed, laparoscopic repair has been described with success. Recurrence rates appear low, but follow-up has been short term.

The syndrome of Spigelian hernia and cryptorchidism: a review of paediatric literature

BACKGROUND/PURPOSE

The purpose of this study is to present a summary of paediatric Spigelian hernia (SH) reported to date, and discuss possible aetiology of SH associated with ipsilateral ectopic testis (SH-ET).

METHODS

Search of PubMed, Medline, Embase, and CINAHL was performed using keywords "Spigelian hernia". The following were extracted from articles describing paediatric SH: demographics, site and contents of SH, comorbidities, proposed aetiology, presence of ipsilateral inguinal canal (IC) and gubernaculum (G).

RESULTS

There were 78 patients with 88 hernias (69 male, 19 female), including 55 male (19 left, 22 right, 7 bilateral) and 16 female (5 left, 5 right, 3 bilateral) nontraumatic SHs. In nontraumatic male SH, 29 hernias contained testis (10 left, 11 right, 4 bilateral), 15 did not, 10 had no data. Of 29 SH-EH, 15 were lacking IC and G, 3 were missing IC (no G data) and 2 had absent G (no IC data). The combination of SH and cryptorchidism is increasingly recognised as a distinct syndrome. However, there is controversy as to the pathogenic mechanism of this association. We hypothesise SH-ET develops because the G, and therefore IC and line of descent, become cranially 'mislocated' along the mammary line, which overlies the Spigelian fascia.

CONCLUSION

SH is rare in children. SH-ET may result by testicular descent to an ectopic site along the embryological mammary line.

Spigelian hernia in a 14-year-old girl: a case report and review of the literature

Spigelian hernia (SH) is a surgical rarity in children, which occurs through slit-like defects in the anterior abdominal wall adjacent to the semilunar line, the convexity lateral line which joins the nine ribs to the pubic tubercle and signs the limit between the muscular and aponeurotic portion of transversus abdominis muscle. As there are no specific symptoms and signs, the diagnosis is difficult, especially in children. We report a case of SH that comes to our observation: a 14-year-old girl presented recurrent abdominal pain associated to intermittent palpable mass in the paraumbilical region. Starting from our case report, we review the literature of pediatric SH from 2000 to 2013 and we describe the anatomy, etiology, clinical presentation, instrumental diagnosis, and surgical technique of pediatric SH.

Repair of a traumatic lateral abdominal wall hernia in an 11-year-old boy, using a minimally invasive approach

We present the case of an 11-year-old boy who sustained blunt abdominal trauma while bicycling. An abdominal computed tomography scan obtained during his trauma evaluation was suspicious of a right-sided abdominal wall hernia with acute inflammatory changes although there was no palpable mass on physical examination. In follow-up, he was found to have a palpable mass in his right lateral abdominal wall, which enlarged with valsalva. The hernia was repaired primarily using a minimally invasive approach with a 5-mm umbilical cannula and a stab incision over the defect. He was discharged home on the first post-operative day. At 1 year follow-up, he is symptom-free without evidence of recurrence. Lateral abdominal wall hernias in the pediatric patient are uncommon but can result from trauma. Primary repair using a minimally invasive approach is safe and effective in achieving adequate closure.

Traumatic spigelian hernia due to handlebar injury in a child: a case report and review of literature

Traumatic abdominal wall hernia is a rare clinical entity despite the high incidence of blunt abdominal trauma. In children, traumatic abdominal wall injury can occur even after minor trauma without any associated intra-abdominal injury. We report a case of Spigelian hernia due to a handlebar injury in a male child of 9 years, who came for treatment 5 weeks after the injury. Ultrasonography confirmed the clinical diagnosis of traumatic Spigelian hernia. The case was taken up for open surgery and anatomical repair was done with prolene. The patient had an uneventful postoperative course.