Spontaneous posterior rectus sheath hernia: a case report

Laparoscopic repair for interparietal hernia after enhanced-view totally extraperitoneal hernia repair: A case report

INTRODUCTION

The enhanced-view totally extraperitoneal (eTEP) technique, an endoscopically performed Rives-Stoppa method, has been used extensively for ventral hernia repairs. However, in this technique, the necessity of posterior rectus sheath re-approximation and mesh fixation remains unclear. There are a few reports of post-eTEP interparietal hernias (IHs) occurring because of dehiscence of the re-approximated posterior rectus sheath; however, IH secondary to mesh migration is rare. Herein, we report a rare case of IH due to mesh migration after eTEP repair for an incisional hernia.

PRESENTATION OF CASE

A 70-year-old man underwent eTEP repair for an incisional hernia using a self-gripping mesh without mesh fixation and posterior rectus sheath re-approximation one year previously, developed an IH. An elective laparoscopic surgery revealed an orifice to the retrorectus space as though the IH sac between the retrorectus muscle and the posterior layer including the bilateral posterior rectus sheaths, peritoneum, and mesh. We placed eight transmural sutures with 0 nylon thread and closed the orifice. The patient was then discharged on postoperative day two and was asymptomatic at 24 months without evidence of ventral hernia recurrence.

DISCUSSION

We consider that strenuous activity and deep bending may cause mesh migration or dislocation. If that occurs in the early post-eTEP period without posterior rectus sheaths closure, the vulnerable peritoneal area will be exposed, which consider to be an IH orifice.

CONCLUSIONS

Even after using the self-gripping mesh in eTEP repair, mesh fixation remains the best option to prevent postoperative complications, including IH.

Posterior Rectus Sheath Hernia Causing Chronic Abdominal Pain

Posterior rectus sheath hernias are rare hernias that can be difficult to diagnose due to unreliable physical exam characteristics and subtle radiological findings. We present an interesting case of an elderly female found to have a posterior rectus sheath hernia during a diagnostic laparoscopy for chronic abdominal pain. CT evaluation revealed possible appendicitis and laxity of the abdominal wall of the right lower quadrant. Intraoperatively, a 4 cm hernia defect in the right lateral abdominal wall was appreciated. Appendectomy and herniorrhaphy with mesh repair were performed. Postoperative review of CT imaging and intraoperative photographs determined that this hernia defect is a posterior rectus sheath hernia likely caused by trocar placement from previous laparoscopic surgery. This report contributes to the limited body of the literature for this rare type of hernia. Posterior rectus sheath hernias should be considered in differential diagnoses for patients presenting with chronic abdominal pain without clear etiology.

Spontaneous Combined Lung and Bowel Herniation Due to Uncontrolled Asthma

Spontaneous lung and bowel hernias are infrequent structural defects secondary to conditions that usually follow bouts of excessive straining. These two conditions have been individually well documented in the literature; however, there are seldom reports of this combination of defects. Here, we describe the case of a 69-year-old man diagnosed with combined spontaneous lung and colon herniation following an episode of severe coughing due to uncontrolled asthma. Early recognition and prompt treatment should be warranted to prevent complications.

Spontaneous posterior rectus sheath hernia: A case report and literature review

INTRODUCTION

Hernias of the posterior rectus sheath are very rare abdominal wall hernias with only around 15 reported cases to date.

CLINICAL PRESENTATION

This case report examines a 27-year-old female who is presented with epigastric abdominal pain and vomiting. An Abdomen CT scan was done and showed signs of SBO and herniation of the small bowel at the posterior rectus sheath. The patient underwent exploratory laparotomy that showed right-sided posterior rectus sheath obstructed hernia, which was repaired with primary closure. Postoperatively, the patient was doing well and was discharged on postoperative day 3 in good general condition.

CONCLUSION

The patient had no complaints during her follow-up at one month. Due to its rarity and potential complications, it is also important to report this case to enhance the evidence base for posterior rectus sheath hernia and to familiarise this uncommon condition to radiologists, clinicians, and surgeons.

Posterior Rectus Sheath Defect with Interparietal Hernia Causing a Small Bowel Obstruction

Posterior rectus sheath hernias are exceptionally rare, with around twelve reported cases to date. This case report examines a 38-year-old female who demonstrated symptoms of intermittent small bowel obstruction five days following an abdominal hysterectomy. The patient was diagnosed via CT to have a small bowel obstruction within the rectus abdominis. Exploratory laparotomy determined the etiology to be an interparietal hernia through a posterior rectus wall defect, which was repaired with primary closure. Postoperatively, the patient was again unable to tolerate food. Repeat CT showed concern for repeat SBO, though symptoms subsided without intervention. The patient had no complaints during her follow up at one month. This report was aimed at building upon the few reported cases as well as enumerating potential risk factors that may allow for the consideration of this diagnosis in the future.

Laparoscopic approach for a spontaneous posterior rectus sheath hernia

Spontaneous posterior rectus sheath hernia is perhaps one of the rarest hernias described only in a few published cases. We present the case of a small bowel herniation through the posterior rectus sheath in a woman without previous abdominal surgical history, resulting in acute small bowel obstruction who was successfully treated by laparoscopy. This is the first case report of this kind of hernia managed with laparoscopic technique. Although the laparoscopic approach is not considered standard treatment for strangulated hernias, in selected cases, it allows the identification and repair of the defect.