共查询到20条相似文献,搜索用时 31 毫秒
1.
We report on a case of a 68-year-old man who was transferred to our department to undergo surgical treatment of intestinal obstruction and a palpable right-sided abdominal mass. The abdominal computed tomography scan revealed a small bowel obstruction with an incarcerated spigelian hernia. A mesh repair was performed by suturing the mesh to the internal oblique muscle and to the rectus sheath. The postoperative course was uneventful, and no recurrence has occurred during the 2-year follow-up. An urgent operation should be performed as soon as an accurate diagnosis of incarcerated spigelian hernia has been made. Computed tomography should be helpful in order to establish an accurate diagnosis of the incarcerated hernia. 相似文献
2.
Summary Spigelian hernia, first described at the 18th century, is a rare ventral abdominal hernia occuring through the spigelian fascia.
The diagnosis is difficult especially when there is no palpable mass. The case presented here had a spigelian hernia mimicking
an incarcerated incisional hernia. This patient had undergone an appendectomy through a right paramedian incision proviously.
Three years later she was operated for a suspected incisional hernia. Exploration did not reveal any defects in the external
oblique aponeurosis so no further exploration was done. Our operative findings showed also an intact external oblique aponeurosis
but when incised a spigelian hernia was observed beneath this structure, which was repaired promptly. A high index of suspicision
is necessary for diagnosis both pre and intraoperatively. 相似文献
3.
Moreno-Egea A Carrasco L Girela E Martín JG Aguayo JL Canteras M 《Archives of surgery (Chicago, Ill. : 1960)》2002,137(11):1266-1268
HYPOTHESIS: The elective treatment of a spigelian hernia is still under discussion, fundamentally owing to its rarity. The purpose of the study is to analyze the elective surgical treatment of spigelian hernia. DESIGN: A prospective, randomized controlled trial. SETTING: University teaching hospital. PATIENTS AND INTERVENTIONS: Two surgeons performed 11 conventional and 11 laparoscopic repairs for a spigelian hernia, alternating roles as primary surgeon and assistant. Each time the type of technique was randomly chosen using a computerized program. MAIN OUTCOME MEASURES: Epidemiological, clinical, and surgical factors are analyzed according to treatment, ie, the open or laparoscopic approach. RESULTS: The statistical study shows no significant differences for epidemiological or diagnostic factors, but it does show significant advantages for laparoscopy in terms of morbidity (P<.05) and hospital stay (P<.001). CONCLUSION: The approach using extraperitoneal laparoscopy is the technique that offers best results in the elective treatment of spigelian hernia. 相似文献
4.
Erick G Martell Niten N Singh Stanley M Zagorski Michael A J Sawyer 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2004,8(3):269-274
BACKGROUND: We present a case in which laparoscopy was both diagnostic and therapeutic in a patient with a spigelian hernia. CASE REPORT: A 35-year-old man was referred to the General Surgery Service for evaluation of right lower quadrant abdominal pain of approximately 6 months. The pain was not disabling but was a constant discomfort. The patient did not have any significant past medical or surgical history, and the physical examination was significant only for an area of focal tenderness in the right lower quadrant. Ultrasound and CT scans of the patient's abdomen were unremarkable. A laparoscopic exploration of the area revealed a defect in the area of semilunar and semicircular lines consistent with a spigelian hernia. The patient underwent a laparoscopic herniorrhaphy with placement of a polypropylene mesh. CONCLUSION: This case illustrates the role of laparoscopy in the diagnosis and treatment of spigelian hernias. 相似文献
5.
Z. Malazgirt K. Topgul S. Sokmen S. Ersin A. G. Turkcapar H. Gok N. Gonullu M. Paksoy M. Ertem 《Hernia》2006,10(4):326-330
Most of the papers published on spigelian hernia are either case reports or small retrospective series. In this prospective
multicenter study, we aimed to outline the specific features of spigelian hernias and patients’ characteristics more clearly.
Surgeons enrolled patients to be entered into the database as they diagnosed and treated the hernias at will. The baseline
and surgical outcome parameters were noted in each patient. A painful mass was the main presenting complaint in half of 34
patients. Accurate preoperative diagnosis was possible in 31 patients. Open intraperitoneal mesh repair was the preferred
technique. The mean hospital stay and time until return to normal daily activities were 4.1 and 15.6 days. Although a rare
condition, diagnosis of a spigelian hernia is not difficult once remembered. Its surgical repair seems to cause few complications
and is very well tolerated by the patient. 相似文献
6.
Catherine Baucom Quan D. Nguyen Marco Hidalgo Douglas Slakey 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2009,13(2):263-268
Introduction:
Spigelian hernia is an uncommon ventral hernia characterized by a defect in the linea semilunaris. Repair of spigelian hernia has traditionally been accomplished via an open transverse incision and primary repair. The purpose of this article is to present 2 case reports of incarcerated spigelian hernia that were successfully repaired laparoscopically using Gortex mesh and to present a review of the literature regarding laparoscopic repair of spigelian hernias.Methods:
Retrospective chart review and Medline literature search.Results:
Two patients underwent laparoscopic mesh repair of incarcerated spigelian hernias. Both were started on a regular diet on postoperative day 1 and discharged on postoperative days 2 and 3. One patient developed a seroma that resolved without intervention. There was complete resolution of preoperative symptoms at the 12-month follow-up.Conclusion:
Minimally invasive repair of spigelian hernias is an alternative to the traditional open surgical technique. Further studies are needed to directly compare the open and the laparoscopic repair. 相似文献7.
A spigelian hernia is a rare cause of acute abdominal pain and its diagnosis is often difficult to make. A CT scan of the patient demonstrated an incarcerated spigelian hernia containing small bowel which had subsequently reduced spontaneously. The patient underwent laparoscopic repair of her spigelian hernia the following day and made a fast and uneventful recovery. This case illustrates the importance of imaging a patient whilst symptomatic if the diagnosis of a spigelian hernia is entertained. 相似文献
8.
Demetrios Moris Adamantios Michalinos Spiridon Vernadakis 《International surgery》2015,100(1):109-111
Describes the existence of endometrioma in a spigelian hernia sac. Spigelian Hernia is a rare ventral hernia, presenting difficulties in diagnosis and carrying a high incarceration and obstruction risk. Endometriomas occur due to implantation of endometrial cells into a surgical wound, most often after a cesarean delivery. A 37-year-old woman presented to our department with persistent abdominal pain, exacerbating during menses, and vomiting for 2 days. Physical examination revealed a mass-like lesion in the border between the left-upper and left-lower quadrant. Ultrasound examination was inconclusive and a computed tomography scan of the abdomen revealed an abdominal wall mass. During surgery, a spigelian hernia was found 5 to 7 cm above a previous cesarean incision. Tissue like “chocolate cysts” was present at the hernia sac. Hernia was repaired while tissue was excised and sent for histological examination that confirmed the diagnosis. Spigelian hernia is a hernia presenting difficulties in diagnosis and treatment. Endometrioma in a spigelian hernia sac is a rare diagnosis, confirmed only histologically. Clinical suspicion can be posed only through symptoms and thorough investigation.Key words: Spigelian hernia, Endometriosis, Cesarean sectionSpigelian hernia (SH) is a rare ventral hernia occurring through semiluminar line and carrying a high incarceration risk. Endometrioma is implantation of endometrial tissue. Authors present a rare case of symptomatic endometriomas discovered within a spigelian hernia sac. 相似文献
9.
Small bowel obstruction: a population-based appraisal 总被引:2,自引:0,他引:2
Foster NM McGory ML Zingmond DS Ko CY 《Journal of the American College of Surgeons》2006,203(2):170-176
BACKGROUND: Small bowel obstruction (SBO) is a common reason for surgical consultation, but little is known about the natural history of SBO. We performed a population-based analysis to evaluate SBO frequency, type of operation, and longterm outcomes. STUDY DESIGN: Using the California Inpatient File, we identified all patients admitted in 1997 with a diagnosis of SBO. Patients were excluded if they had a diagnosis of bowel obstruction in the previous 6 years (1991 to 1996). Of the remaining cohort, the natural history of SBO over the subsequent 5 years (1998 to 2002) was analyzed. Index hospitalization outcomes (eg, surgical versus nonsurgical management, length of stay, in-hospital mortality), and longterm outcomes, including SBO readmissions and 1-year mortality, were evaluated. RESULTS: We identified 32,583 patients with an index admission for SBO in 1997; 24% had surgery during the index admission. The distribution of surgical procedures was: 38% lysis of adhesions, 38% hernia repair, 18% small bowel resection with lysis of adhesions, and 6% small bowel resection with hernia repair. Patients who underwent operations during index admission had longer lengths of stay, lower mortality, fewer SBO readmissions, and longer time to readmission than patients treated nonsurgically. Regardless of treatment during the index admission, 81% of surviving patients had no additional SBO readmissions over the subsequent 5 years. CONCLUSIONS: Most of the 32,583 patients requiring admission for index SBO in 1997 were treated nonsurgically, and few of these patients were readmitted. This is the first longitudinal population-based analysis of SBO evaluating surgical versus nonsurgical management and outcomes, including mortality and readmissions. 相似文献
10.
M. Zuvela M. Milicevic D. Galun A. Djuric-Stefanovic P. Bulajic I. Palibrk 《Hernia》2013,17(4):483-486
Purpose
Only a few series of patients with a spigelian hernia managed on an outpatient basis have been reported in the literature. The aim of this prospective study was to evaluate the results of the elective spigelian hernia repair as an ambulatory procedure.Methods
From June 2007 to June 2010, 8 patients with 9 spigelian hernias were electively operated on under local anesthesia as a day case. Four patients had unilateral spigelian hernia, 1 had spigelian and inguinal on the same side, 1 had spigelian and epigastric, 1 had spigelian and umbilical, and 1 patient had bilateral spigelian and umbilical hernia. Spigelian hernia was managed by the “open preperitoneal flat mesh technique.” In patients with several ventral hernias at different sites, “the open preperitoneal flat mesh technique” was performed using one separate flat mesh for each of the hernias; for the patient with inguinal hernia, the Lichtenstein procedure was performed in addition.Results
No complications and recurrences were recorded during a mean follow-up of 23.5 months (range: 11–35).Conclusion
The elective spigelian hernia can be successfully repaired under local anesthesia as a day-case procedure. The “open preperitoneal flat mesh technique” provides excellent results under these conditions. 相似文献11.
Only seven cases of spigelian hernia recurrence have been previously reported. We report the case of a 75-year-old male patient who presented with extremely large hernia after four unsuccessful suture repairs over 12 years. The abdominal wall defect was repaired with Marlex mesh. The advantage of using prosthetic mesh in both primary and recurrent spigelian hernia is supported by recent clinical research data indicating a generalized collagen metabolism disorder in patients with primary and recurrent hernia. Mesh repair allows for tension-free anatomic restoration of distorted tissues associated with repair failures. 相似文献
12.
Nagarsheth KH Nickloes T Mancini G Solla JA 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2011,15(1):81-85
Background and Objectives:
A Spigelian hernia is a rare type of hernia that occurs through a defect in the anterior abdominal wall adjacent to the linea semilunaris. Estimation of its incidence has been reported as 0.12% of all abdominal wall hernias. Traditionally, the method of repair has been an open approach. Herein, we discuss a series of laparoscopic repairs.Methods:
Case series and review of the literature.Cases:
Three patients are presented. All were evaluated and taken to surgery initially for a different disease process, and all were incidentally found to have a spigelian hernia. These patients underwent laparoscopic repair of their hernias; 2 were repaired intraperitoneally and one was repaired totally extraperitoneally. Two patients initially underwent a mesh repair, while the third had an attempted primary repair.Conclusions:
There is evidence that supports the use of laparoscopy for both diagnosis and repair of spigelian hernias. There are also reports of successful repairs both primarily and with mesh. In our experience with the preceding 3 patients, we found that laparoscopic repair of incidentally discovered spigelian hernias is a viable option, and we also found that implantation of mesh, when possible, resulted in satisfactory results and no recurrence. 相似文献13.
Carcinoma of the sigmoid presenting as a right inguinal hernia 总被引:1,自引:0,他引:1
We present the case of a 44-year-old man who presented with nausea, vomiting and acute pain in the right groin. On physical
examination an irreducible mass was palpated in the right inguinal region. Ultrasound suggested an inguinal hernia sac with
bowel contents. Subsequent right inguinal exploration revealed only unspecified necrotizing tissue, but no hernia sac or bowel
contents were identified. Two days later laparotomy was required since the inguinal wound produced faecal discharge. The sigmoid
appeared to be necrotic and perforated, and was subsequently resected. Histology revealed a perforated adenocarcinoma without
lymph node involvement. Incarcerated inguinal hernias containing an adenocarcinoma of the colon are rare, but should be considered
in patients presenting with an irreducible palpable mass in the inguinal region. Moreover, a carcinoma of the sigmoid may
invade the right inguinal region. An intestinal perforation to skin-level in this population is even rarer and is associated
with high morbidity and mortality rates. 相似文献
14.
Spigelian hernia is a rare partial
abdominal wall defect. The frequent lack of physical findings along
with vague associated abdominal complaints makes the diagnosis elusive.
A retrospective review of Mayo Clinic patients was performed to find
all patients who had undergone surgical repair of a Spigelian hernia
from 1976 to 1997. Patients were scrutinized for presentation, work-up,
therapy, and outcome. The goal of this study was to obtain long-term
outcome. The study was set in a tertiary referral center. There were 76
patients in whom 81 Spigelian hernias were repaired. Symptoms most
commonly included an intermittent mass (n = 29), pain
(n = 20), pain with a mass (n = 22),
and bowel obstruction (n = 5). Five patients were
asymptomatic. Preoperative imaging was performed in 21 patients and
correctly diagnosed the hernia in 15. Spigelian hernias were repaired
by primary suture closure (n = 75), mesh
(n = 5), and laparoscopic (n = 1)
techniques. Eight patients (10%) required emergent operations.
Thirteen hernias (17%) were found to be incarcerated at the time of
the operation. Overall mean follow-up for the 76 patients was 8 years,
with three hernia recurrences identified. Spigelian hernia is rare and
requires a high index of suspicion given the lack of consistent
symptoms and signs. An astute physician may couple a proper history and
physical examination with preoperative imaging to secure the diagnosis.
Mesh and laparoscopic repairs are viable alternatives to the durable
results of standard primary closure. Given the high rate of
incarceration/strangulation, the diagnosis of Spigelian hernia is an
indication for surgical repair. 相似文献
15.
The aim of this article is to provide a review of six patients with the various stages of obturator hernia and a diagnostic and therapeutic strategy in suspected cases. Obturator hernia is relatively rare and is a diagnostic challenge. It is a significant cause of intestinal obstruction, especially in emaciated elderly women with chronic disease. A palpable groin mass is not common in these patients because the hernia mass is usually concealed beneath the pectineus muscle. The high mortality is directly related to the delayed recognition, with resultant ruptured gangrenous bowel, and to the high incidence of patients with concurrent medical illness. A total of six patients with obturator hernias were treated at this hospital between 1994 and 2004, and one of these patients was diagnosed and treated by elective laparoscopy. We reviewed these six cases and examined the clinical presentation, age, body weight, associated medical conditions, preoperative diagnosis, operative findings, complications, and outcome in this retrospective study. We concluded that we cannot shorten the time from onset of symptoms to admission, but what we can do is to make a rapid evaluation and surgical intervention to reduce the morbidity and mortality from obturator hernia. The approaches to different presentation of obturator hernia and diagnostic role of CT scan are also discussed. 相似文献
16.
Mamta Sengar Anup Mohta Sujoy Neogi Alisha Gupta Vivek Viswanathan 《Journal of pediatric surgery》2018,53(11):2346-2348
Purpose
Pediatric spigelian hernias are very rare. They are often missed or misdiagnosed. A series of cases with spigelian hernia, presented to a tertiary care center are presented here with emphasis on different anatomy of spigelian hernias with cryptorchidism and those without associated cryptorchidism.Materials and Methods
Over a period of seven years, nine cases of spigelian hernia presented to our tertiary care center. Male:female ratio was 3:1.There was a preponderance of right sided hernias. Three patients had associated cryptorchidism. One patient had associated lumbar hernia. All three patients with cryptorchidism had low spigelian hernia while others had classical spigelian hernia.Conclusion
There is a likelihood of anatomical variation in SH associated with UDT and those without UDT. Understanding this anatomy may help in correct scrotal placement of testis.Type of Study
Prospective Observational.Level of Evidence
4. 相似文献17.
BACKGROUND: This study aimed to evaluate the utility of ultrasound in the diagnosis of inguinal hernias and obscure groin pain. METHODS: A series of 65 consecutive groin explorations performed subsequently to percutaneous ultrasound examination were prospectively evaluated. Patients were examined in an office setting. The examination included a history and a physical. Then an ultrasound of the inguinal region was performed. Ultrasound was performed by the staff surgeon and fellows. Patients then were taken to surgery for either a laparoscopic or open hernia repair. The preoperative and operative findings were compared to determine the utility of groin ultrasound. RESULTS: A series of 41 patients presenting with symptoms of groin pain or palpable groin bulge were evaluated with ultrasound of the groin. Of these patients, 24 went on to have bilateral repairs, bringing the study total to 65 groins. Surgery involved 50 laparoscopic and 15 open hernia repairs. This included 20 groins without hernia, as determined by physical examination, and 45 groins with a palpable hernia. Overall, ultrasound was used to identify the type of hernia correctly (direct vs indirect) with 85% success. In the 20 patients who had no palpable bulge, ultrasound identified a protrusion (hernia or lipoma) in 17. Two of these were false positives, and the three negative ultrasound examinations were false negatives. Thus ultrasound identified the pathology in a groin without a palpable bulge at an accuracy of 75%. The overall accuracy in finding a hernia of any kind by ultrasound was 92%. CONCLUSION: Ultrasound is a useful adjunct in evaluating the groin for hernia, and can be performed by surgeons. 相似文献
18.
BACKGROUND: Missed lipoma of the spermatic cord is a pitfall unique to the transabdominal preperitoneal (TAPP) laparoscopic hernia repair. This problem occurs when a palpable inguinal mass is noted preoperatively, but no identifiable hernia defect is found at time of laparoscopy and the procedure is terminated. METHODS: Our group encountered six patients without intraperitoneal defects that had large cord lipomas on preperitoneal exploration. Two of these patients had undergone previous intraabdominal laparoscopy for a proposed TAPP repair, which was aborted when no defect was seen. RESULTS: Both patients were referred for continued symptomatic groin masses, which were subsequently treated by lipoma resection in conjunction with inguinal floor repair. CONCLUSIONS: When patients present with a groin mass, exploration of the preperitoneal space and cord structures is indicated during TAPP repair, even in the presence of a normal-appearing abdominal floor. Abandoning a transabdominal approach without exploration of the preperitoneal structures may lead to a failure to identify symptomatic and/or palpable cord lipomas. 相似文献
19.
Cascales-Sanchez P Martinez-Moreno A Vazquez-Aragon P Miota-De Llama JI Gallego-Valcarcel E Llamas-Fuentes F Moreno-Resina JM 《Transplantation proceedings》2007,39(7):2267-2268
Renal paratransplant hernia constitutes an unusual variant of internal hernia caused by entrapment of bowel through a defect in the peritoneum covering the transplanted kidney. Only three cases have been previously reported. We present three new cases of renal paratransplant hernia. Abdominal pain and vomiting were the main symptoms. Clinical diagnosis of bowel obstruction and paratransplant hernia was reached using abdominal CT scan. All patients underwent an emergency surgical procedure, and one patient needed resection of necrotic bowel. The three patients survived owing to early surgical intervention, and they were discharged asymptomatic. Paratransplant hernia represented 1.1% of our series of transplant patients. Early diagnosis and surgical treatment are esential in transplant patients with bowel obstruction to avoid high morbidity and mortality rates. 相似文献
20.
Lateral ventral hernias are found in the spigelian fascia lateral to the junction of the arcuate and semilunar lines and below the level of the umbilicus. Three cases are reported in infants and children. Diagnosis depends on finding an unusual mass on the anterior abdominal wall and palpation of the rim of the hernia defect upon reduction of the mass. A spigelian hernia may be misdiagnosed easily if the examiner is unaware that it can occur in childhood. The edge of the defect must be outlined while the child is straining, prior to induction of anesthesia, as the rim may be difficult to find when the patient is asleep. 相似文献