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Nadirov N, Vissarionov S, Khusainov N, Filippova A, Sazonov V. Abdominal pseudohernia in a child after surgical correction of congenital scoliosis: case report. Front Pediatr 2024; 11:1211184. [PMID: 38274472 PMCID: PMC10808609 DOI: 10.3389/fped.2023.1211184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Abdominal wall relaxation is a rare complication of various surgical procedures or diseases, when the intercostal or upper lumbar nerves are affected, and the innervation of the muscles of the abdominal wall is damaged. The result is a mass that can visually mimic a ventral hernia. We present a clinical case and the results of a literature review on this topic. Clinical case The 2 years 5 months patient diagnosed with a congenital deformity of the spine (posterolateral hemivertebra) underwent extraction of the hemivertebra from the retroperitoneal approach. In the postoperative period, a pseudohernial protrusion of the anterior abdominal wall was observed. 4.5 months later the protrusion resolved spontaneously. Discussion Abdominal wall relaxation is studied worldwide and is presented primarily as clinical case reports, mainly in older patients with neurological diseases. Single cases of this pathology are described among children. The Th10-Th12 roots are most often affected. Possible manifestations include: bloating and abdominal pain, pseudo-obstruction of the small and/or large intestine, and constipation. In the described case, only unilateral bloating at rest was observed, which increased with crying and strain. The natural course and prognosis of this diagnosis are usually favorable-the recovery period, according to the literature, takes an average of 4-5 months, which also coincided with our case. Conclusion Pseudohernias are a rare complication and may can occur during correction of spinal deformities in children. This condition is a transient disorder of the anterior abdominal wall muscles, the cause of which may be neuropathy caused by infection, metabolic disorders, or mechanical damage. The main principles of treatment of this condition include active observation and symptomatic therapy. The prognosis is usually favorable.
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Affiliation(s)
- Nurbek Nadirov
- Department of Orthopedics, Mother and Child Health Center, University Medical Center, Astana, Kazakhstan
| | - Sergey Vissarionov
- Department of Spine Pathology and Neurosurgery, G. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - Nikita Khusainov
- Department of Spine Pathology and Neurosurgery, G. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - Alexandra Filippova
- Department of Spine Pathology and Neurosurgery, G. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - Vitaliy Sazonov
- Department of Surgery, School of Medicine, Nazarbayev University, Astana, Kazakhstan
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Cho WJ, Kim KW, Kim BH, Ryu JH. Monoradiculopathy-induced abdominal pseudohernia caused by T11-12 soft disc herniation: a case report and literature review. BMC Musculoskelet Disord 2023; 24:428. [PMID: 37248511 DOI: 10.1186/s12891-023-06536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND An abdominal pseudohernia is a rare clinical entity that consists of an abnormal bulging of the abdominal wall that can resemble a true hernia but does not have an associated underlying fascial or muscle defect. Abdominal pseudohernia is believed to result from denervation of the abdominal muscles in cases of herpes zoster infection, diabetes mellitus, lower thoracic or upper lumbar disc herniation, surgical injuries, and rib fracture. To date, nine cases of abdominal pseudohernia caused by disc herniation at the lower thoracic or upper lumbar levels have been reported. CASE PRESENTATION A 35-year-old man with no underlying disease or traumatic event presented with chief complaints of left flank pain and a protruding left lower abdominal mass that had formed one day earlier. There was no true abdominal hernia on abdominal computed tomography (CT), although CT and magnetic resonance imaging (MRI) showed a herniated soft (non-calcified) disc into the left neural foramen at the T11-12 level. A nonsteroidal anti-inflammatory drug was prescribed for the flank pain, and the patient was followed on a regular basis for six months. Follow-up MRI taken at the last visit showed complete resorption of the herniated disc. Abdominal pseudohernia and flank pain were also completely resolved. CONCLUSION We report a rare case of monoradiculopathy-induced abdominal pseudohernia caused by foraminal soft disc herniation at the T11-12 level. In patients who have an abdominal pseudohernia without herpes zoster infection, diabetes mellitus, or traumatic events, lower thoracic disc herniations should be included in differential diagnosis.
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Affiliation(s)
- Wan-Jae Cho
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Ki-Won Kim
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Bo-Hyoung Kim
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Ji-Hyun Ryu
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea.
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Abdominal wall pseudohernia - One secondary to a thoracic extraforaminal disc herniation and other due to thoracic paracentral disc protrusion. J Clin Orthop Trauma 2022; 30:101897. [PMID: 35646588 PMCID: PMC9133734 DOI: 10.1016/j.jcot.2022.101897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 11/21/2022] Open
Abstract
An abdominal wall pseudohernia is a rare clinical entity which consists of an abnormal bulging of the abdominal wall that can resemble a true hernia, but without an associated underlying fascial or muscle defect. It is caused by segmental neuropathy and subsequent denervation of abdominal wall musculature. We present two cases of an abdominal wall pseudohernia. One secondary to a thoracic extraforaminal disc herniation in a 57-year-old male, which, as far as the authors are aware, has not been described previously. The other in a 67 year old male due to right foraminal and paracentral disc protrusion at T9/10.
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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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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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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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Irwin RS, Dudiki N, French CL. Life-Threatening and Non-Life-Threatening Complications Associated With Coughing: A Scoping Review. Chest 2020; 158:2058-2073. [PMID: 32565267 DOI: 10.1016/j.chest.2020.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This is an update of the section on complications that are associated with coughing in the 2006 CHEST cough guidelines that addresses two aims: (1) to systematically identify and thematically categorize the diverse complications of cough by providing a guide for future studies and (2) to identify gaps in the literature for future research. RESEARCH QUESTION What are the potential complications that are associated with the act of coughing that have been reported in infants, children, adolescents, and adults? STUDY DESIGN AND METHODS A scoping review was performed with the use of PubMed and SCOPUS databases that were searched from their beginning until September 6, 2019. RESULTS Two hundred forty-seven publications met our inclusion criteria. To these, we added 38 articles from the 2006 complications paper that were not identified in the literature search plus the paper itself for a final total of 286 publications that formed the basis of this review. Since 2006, three new categories of complications have been reported: ear, nose and throat; disease transmission; and laboratory testing. Multiple additional complications that fall outside of these three categories have also been identified and included in the following categories: cardiovascular, constitutional symptoms, dermatologic, GI, genitourinary, musculoskeletal, neurologic, ophthalmologic, psychosocial/quality of life, and respiratory. Not previously highlighted is that some of the complications led to serious morbidity that included death, especially in patients with comorbid conditions, and potentially resulted in harm to others when cough resulted in a motor vehicle accident. INTERPRETATION Our work identified a large number of cough complications that we thematically categorized primarily by organ system so that future studies of each system or each complication can be conducted. The gap in the literature that future studies should address is to identify the frequency of the complications and the strength of their association with cough. Only then will one be able to describe the findings in a manner that allows specific recommendations for avoiding these complications. In the meantime, patients with cough should be evaluated and treated according to evidence-based guidelines to mitigate or prevent the myriad of potential complications that are associated with coughing.
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Affiliation(s)
- Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA.
| | - Natasha Dudiki
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Cynthia L French
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
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- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
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Abou-Al-Shaar H, Mahan MA. Subcostal nerve injury after laparoscopic lipoma surgery: an unusual culprit for an unusual complication. J Neurosurg 2019; 131:1855-1859. [PMID: 30579276 DOI: 10.3171/2018.7.jns18532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/31/2018] [Indexed: 11/06/2022]
Abstract
Endoscopic surgery has revolutionized the field of minimally invasive surgery. Nerve injury after laparoscopic surgery is presumably rare, with only scarce reports in the literature; however, the use of these techniques for new purposes presents the opportunity for novel complications. The authors report a case of subcostal nerve injury after an anterior laparoscopic approach to a posterior abdominal wall lipoma.A 62-year-old woman presented with a left abdominal flank bulge (pseudohernia) that developed after laparoscopic posterior flank wall lipoma resection. Imaging demonstrated frank ballooning of the oblique muscles; denervation atrophy and thinning of the external oblique, internal oblique, and transverse abdominis muscles; and thinning of the rectus abdominis muscle. The patient underwent subcostal nerve repair and removal of a foreign plastic material from the laparoscopic procedure. At 8 months, she has regained substantial improvement in abdominal wall strength.Although endoscopic procedures have resulted in significant reduction in morbidity, "minimally invasive" approaches should not be confused with "low risk" when approaching novel pathology. The subcostal nerve is at risk of injury in posterior abdominal wall surgery, whether laparoscopic or not. With the pseudohernia and abdominal bulge after this surgery, the cosmetic appeal of laparoscopic incisions was definitively undone. Selecting an approach based on the anatomy of adjacent structures may lead to a better functional result.
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Affiliation(s)
- Hussam Abou-Al-Shaar
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
- 2Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Mark A Mahan
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
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Greiffenstein P, Tran MQ, Campeau L. Three common exposures of the chest wall for rib fixation: anatomical considerations. J Thorac Dis 2019; 11:S1034-S1043. [PMID: 31205760 DOI: 10.21037/jtd.2019.03.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although surgical fixation of rib fractures is increasingly being performed around the world, very little has been published on how to access the chest wall itself. Having performed over one hundred rib fixations in our institution in the past five years, our surgical technique has evolved as more has come to be understood about these types of injuries through examination of the literature, our own experience, and discussions with colleagues experienced in treating these patients. Retrospective chart review of our trauma registry revealed prevalent fracture patterns and we sought to describe the three simple approaches to the chest wall that we most commonly use based on these data and validated through cadaveric dissections. What follows is a description of our experience with surgical fixation and analysis of the anatomy based on functional approaches to common injury patterns. Analysis of CT scans of patients with flail chest injuries revealed the most commonly encountered in our patients requiring surgical fixation. We identified three basic incisions used to access the areas of interest in a majority of cases. Careful cadaveric dissections allowed us to provide a detailed description of what portions of the chest wall would be accessible through each with and without sparing of the chest musculature. This paper describes viable options for approaching the chest wall for most rib fracture patterns in need of surgical fixation. This is not comprehensive review, but merely presents some of the effective alternatives to a standard thoracotomy as an approach to the chest wall with the hope and expectation that future publications will expand and improve upon the techniques described here.
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Affiliation(s)
- Patrick Greiffenstein
- Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Michael Q Tran
- Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Lisa Campeau
- Department of Cell Biology and Anatomy, Louisiana State University Health Science Center, New Orleans, LA, USA
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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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Abstract
Loss of tone of the anterolateral abdominal wall muscles due to denervation injury is quite common after open renal surgery by lumbotomy incision. Although rare, flank bulge following percutaneous nephrolithotomy (PCNL) after supracostal approach has been reported in literature. But pseudohernia after PCNL with subcostal access has not been reported yet. In this case report, we present the rare complication of an abdominal wall bulge that occurred after PCNL with a subcostal access. The index case had been operated for a partial staghorn calculus with lower calyceal extension. PCNL with subcostal approach was used. Complete stone-free status was achieved with an uneventful recovery. During the first follow-up after 1 week, an unsightly, painless flank bulge was noticed, which continued to persist till 9 months of periodic follow-up.
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Affiliation(s)
| | - Arup Deb
- Department of Surgery, Apollo Hospitals, Guwahati, India
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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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16
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Alonso F, Graham R, Rustagi T, Drazin D, Loukas M, Oskouian RJ, Chapman JR, Tubbs RS. The Subcostal Nerve During Lateral Approaches to the Lumbar Spine: An Anatomical Study with Relevance for Injury Avoidance and Postoperative Complications Such as Abdominal Wall Hernia. World Neurosurg 2017; 104:669-673. [DOI: 10.1016/j.wneu.2017.05.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 11/30/2022]
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