Primary perineal hernia: a case report and review of the literature

Abstract Pelvic floor hernias are extremely rare. This study presents a successfully treated case of primary perineal hernia and takes a look at the existing literature. Case The case of a 75-year-old female patient with a great perineal hernia is presented. Diagnosis was secured by magnetic resonance tomography. The pelvic defect was successfully treated by primary suture with Prolene. Discussion The literature shows many different approaches for treatment of perineal hernia, such as open or laparoscopic mesh repair, and perineal, abdominal or combined access. Our case confirms that primary closure of the hernial orifice through an abdominal approach is also feasible.     

经腹股沟切口Kugel腹股沟疝修补术应用体会(附50例报告)

目的探讨经腹股沟切口应用Kugel腹股沟疝修补术的优点,以及其在早期学习者中如何掌握标准时所起的作用。方法回顾性总结、分析自2003年3月至2004年2月间所作50例经腹股沟切口Kugel腹股沟疝修补术的经验。结果本组50例,包括Ⅱ型者30例,Ⅲ型者14例,Ⅳ型者6例;其中10例分别伴有精索鞘膜积液、精索囊肿、精索脂肪瘤、子宫圆韧带囊肿,术中一并切除。47例得到随访,随访率94%,随访时间3～15个月,平均7.4个月。术后发生阴囊水肿3例,无一例有感染、复发、腹股沟区慢性疼痛、睾丸萎缩、射精痛等并发症发生。结论经腹股沟切口作Kugel腹股沟疝修补术不仅具有标准Kugel法的一切优点,同时还能作为早期学者掌握标准Kugel术的一个重要手段。     

网塞式疝修补术的改进--网塞单针缝合固定法

目的：探讨网塞式疝修补术中网塞固定技术的改进及其临床应用价值。方法：2003年4月～2004年12 月共对114例次斜疝和43例次直疝(包括8例次复发疝)实施了改良的网塞式疝修补术。在疝环充填式疝修补术的 基础上，将巴德网塞完全放至筋膜后腹膜前间隙，固定网塞仅缝合1针，将内瓣缝在腹横筋膜上，直疝和缺损大的斜 疝须适当缝合筋膜组织重建腹股沟管后壁。结果：手术操作更加简化，手术并发症少。随访中未发现网塞移位、脱出。 有1例复发，但手术证实网塞固定是可靠的，网塞修复缺损是成功的。结论：网塞单针缝合固定法是一种操作简便、 安全和可靠的手术技术，适合临床推广。     

疝环充填式无张力疝修补术在老年腹股沟疝中的应用（附１２１例报告）

目的 总结老年疝环充填式无张力疝修补术的近期治疗效果。方法 全部采用mesh-plug定型产品行疝环充填式无张力修补。结果 １２１例均手术过程顺利,术后并发尿潴留６例,阴囊积液４例,伤口持续疼痛２例,度隆起伴异物感２例,切口下血肿２例。随访１－２４个月,短期复发２例。结论 疝环充填式无张力疝修补术是一种完全符合生理解剖,具有手术方法操作简单、创伤小、无张力、省时、近期疗效满意及复发率低的理想疝修补术,尤其适合老年和（或）伴有其它疾病者。     

Two case reports of perineal hernia after laparoscopic abdominoperineal resection with a proposed modification to the operative technique

Perineal hernia is a rare complication following laparoscopic abdominoperineal resection (APR) for rectal cancer. We present two case reports of perineal hernia following laparoscopic APR and discuss their management. We suggest that they developed because the pelvic peritoneum was left open during laparoscopic APR and propose that closure of the pelvic peritoneum should be routine in this operation.     

Pelvic leiomyoma presenting as perineal hernia

Primary perineal hernias are rare and can be a diagnostic challenge. We report the case of a 45-year-old female patient who presented with painless perineal swelling suggestive of perineal hernia. Computed tomography (CT) scanning revealed a pelvic mass herniating through the pelvic floor into the perineum. The lesion was completely excised by an abdominoperineal approach. Histopathological examination of the lesion revealed a leiomyoma. This case report suggests that the possibility of perineal herniation of a pelvic leiomyoma should be considered in a female patient with suspected primary perineal hernia. We recommend an abdominoperineal approach for the surgical management of such a lesion.     

Tension gastrothorax: a case report and review of literature

Background

Tension gastrothorax develops when the stomach, herniated through a congenital diaphragmatic defect into the thorax, is massively distended by trapped air. We report a case of tension gastrothorax and review the literature.

Case Report

A previously healthy 8-month-old female presented with severe respiratory distress, misdiagnosed as tension pneumothorax. Intercostal tube was inserted. The tube was noted to drain food as well as air. The patient was investigated by radio-contrast swallow, which demonstrated the presence of the stomach in the chest. The patient was operated upon, and the stomach, transverse colon, and spleen were reduced back to the abdomen. The defects in the stomach and diaphragm were closed.

Conclusion

Tension gastrothorax is a life-threatening condition leading to acute and severe respiratory distress. The presence of air-filled structure in left hemithorax in a previously healthy child presenting with acute respiratory distress should prompt the inclusion of tension gastrothorax in the differential diagnosis.     

会阴部血管肌纤维母细胞瘤一例报告

血管肌纤维母细胞瘤临床罕见,其临床及影像学表现缺乏特异性。2019年10月菏泽市立医院收治1例会阴部血管肌纤维母细胞瘤患者,予手术治疗,术后经病理检查确诊。     

Secondary perineal hernia following open abdominoperineal excision of the rectum: report of a case and review of the literature

This is a case report of a 46-year-old man who presented with a painful perineal lump four months after abdominoperineal excision of the rectum (APER) with pre-operative radiotherapy and adjuvant chemotherapy. Perineal hernia (suspected clinically) was confirmed by magnetic resonance imaging, and the patient underwent open Permacol mesh repair via a perineal approach. Symptomatic perineal herniation after surgical resection is a rare phenomenon, and the approach to management remains challenging. Several different surgical approaches and techniques of repair have been described. In this report, we review the literature surrounding the presentation, aetiology and repair of this unusual post-operative complication. Furthermore, our case confirms that closure of the hernial orifice with mesh via a perineal approach is a satisfactory technique.     

完全腹膜外腹腔镜疝修补术16例报告

目的　探讨完全腹膜外腹腔镜腹股沟疝修补术的方法。　方法　 16例腹股沟疝行完全腹膜外腹腔镜疝修补术 (TEP) ,其中斜疝 14例 ,直疝 2例。　结果　手术全部成功 ,手术时间 6 5 6 (40～12 0 )min ,术后平均住院 3 7(3～ 7)d。无并发症发生。术后无疝复发。　结论　TEP是一种有效的疝修补技术 ,且复发率低、并发症发生率低。     

Ileal strangulation by a secondary perineal hernia after laparoscopic abdominoperineal rectal resection: A case report

IntroducitonWe report a recent case of strangulated bowel obstruction due to an incarcerated secondary perineal hernia that developed after laparoscopic rectal resection.Presentation of caseA 75-year-old man undergoing treatment for alcoholic cirrhosis underwent laparoscopic abdominoperineal resection of the rectum (APR) for lower rectal cancer after preoperative chemoradiotherapy. Lung metastases were diagnosed 2 months postoperatively. Ten days after chemotherapy initiation, the patient was hospitalized on an emergency basis due to hepatic encephalopathy. Ten days thereafter, we observed perineal skin protrusion. Moreover, the skin disintegrated spontaneously, resulting in ascetic fluid outflow. Pain and fever developed, with inflammatory reactions. Contrast-enhanced computed tomography showed strangulated small bowel obstruction due to perineal hernia. We performed an emergency surgery, during which we found small intestine wall incarcerated in the pelvic dead space, with thickening and edema; no necrosis or perforation was observed. We performed internal fixation by introducing an ileus tube into the ileocecum and fixing its balloon at the cecal terminus.DiscussionSecondary perineal hernia is rare and can develop after APR. Its prevalence is likely to increase in future because of the increasing ubiquity of laparoscopic APR, in which no repair of peritoneal stretching to the pelvic floor is performed. However, only two case of secondary perineal hernia causing strangulated bowel obstruction has been reported in the literature. The follow-up evaluation of our procedures and future accumulation of cases will be important in raising awareness of this clinical entity.ConclusionWe suggest that the pelvic floor and the peritoneum should be repaired.     

Central perineal hernia mimicking rectocele: a case report

Background A perineal hernia is a very rare clinical finding. Three forms are distinguished: anterior, posterior, and central. Diagnosis of the last one is difficult, and sometimes, it is falsely named a posterior rectocele. Aim This work presents a successfully treated case of central perineal hernia and makes a brief summary of existent literature on the problem. Presentation of the case We report of a 67-year-old female patient with a symptomatic central pelvic floor hernia. After radiological confirmation of the diagnosis, a transperitoneal approach was chosen to reposition the protruded segment of the small bowel. The hernial orifice was closed by extraperitoneal implantation of a polypropylene mesh. Discussion In the present case, the use of a laparoscopic technique seemed unsuitable due to the extension of the findings. For the repair of perineal hernia, we followed the principles of the “tension-free” concept. If there are no signs of a pelvic floor infection and if the mesh can be implanted totally extraperitoneally, we recommend the use of nonabsorbable alloplastic material (polypropylene) for reinforcement of the pelvic floor as a suitable technique for the repair of large perineal hernias.     

平片无张力修补术在腹股沟斜疝、直疝中的应用

目的探讨平片无张力修补术在治疗腹股沟斜疝、直疝中的价值.方法回顾总结我院自1998年2月至2001年6月行平片无张力修补术治疗腹股沟斜、直疝163例患者的临床资料.其中腹股沟斜疝154例,直疝9例.初发疝155例,复发疝8例.疝环直径＜2.5 cm 148例,疝环直径≥2.5 cm 15例.急诊手术12例.年龄65岁以上占30.1%.结果本组随访6～36个月,术后5例复发(3.1%),无死亡,术后能早期下床活动,无局部牵拉感,疼痛轻,5～10 d恢复正常生活或工作.复发率较低.结论平片无张力修补术在腹股沟斜疝、直疝的治疗中具有手术创伤小,患者恢复快,术后复发率较低,比疝环充填式无张力修补术费用低等优点.适用于初发性或复发性腹股沟斜疝、直疝和疝环较大但腹横筋膜无明显薄弱的腹股沟斜疝、直疝以及嵌顿性斜疝的急诊手术.     

Use of bone anchors in perineal hernia repair: a practical note

Background Bone anchoring systems are used extensively in orthopaedic surgery but have scarcely been reported as useful in abdominal wall or perineal hernia repair. After coccygectomy or sacrectomy the development of bowel herniation is not uncommon. Considering repair of such a perineal hernia, adequate fixation of the prosthetic mesh is difficult and, therefore, recurrence is rather frequent, mostly due to insufficient anchoring of the mesh to the bony structures.Methods We discuss a patient in which the Mitek GII anchoring system was used to overcome the problem of soft-tissue-to-bone attachment in such cases.Conclusion Bone anchoring systems seem to be an efficient method to overcome the problems of soft-tissue-to bone attachment in both abdominal and perineal hernia repair.     

Robot-assisted laparoscopic repair of perineal hernia after abdominoperineal resection: A case report and review of the literature

IntroductionPerineal hernia is a protrusion of the pelvic floor containing intra-abdominal viscera. The occurrence of postoperative perineal hernia after abdominoperineal resection (APR) is rare, but reports have indicated a recent increase in occurrence following surgical treatment for rectal cancer. This has been attributed to a shift towards extralevator abdominoperineal resection, together with more frequent and long-term use of neoadjuvant therapy.Presentation of caseHere, we report the case of a patient who underwent APR for cancer. Twenty months postoperative, a perineal hernia was detected. The patient was electively scheduled for surgery. Robot-assisted laparoscopy was performed using the da Vinci Surgical System. The perineal hernia was repaired by primary closure with the placement of Symbotex Composite mesh as reinforcement for the pelvic floor. The surgery was performed without any adverse events, and the patient was discharged the day after surgery. Clinical follow-up proceeded at the designated time intervals without difficulties.DiscussionRecurrence rates of perineal hernia remain high, and surgeons face numerous challenges related to poor view, suturing and mesh placement in the deep pelvis. Numerous approaches have been described, but there is still no consensus as to the optimal repair technique for perineal hernia.ConclusionSymptomatic perineal hernias can feasibly be repaired with robot-assisted laparoscopy. Furthermore, suturing and mesh placement require less effort with the robot approach when compared to the open and laparoscopic approaches. These promising findings are demonstrated in the included video.     

巴德3DMax补片完全腹膜外腹腔镜疝修补术21例报告

目的总结腹腔镜完全腹膜外疝修补术（TEP）的方法和手术经验技巧。方法回顾分析21例腹股沟疝患者临床资料,其中斜疝19例,直疝2例,应用巴德3DMax补片行无钉合TEP。结果手术全部成功,手术时间50—100min,术后平均住院3～7d。无严重并发症发生,术后无疝复发。结论应用巴德3DMax补片行无钉合TEP手术安全可靠,可缩短手术时间,减少术后并发症。     

Laparoscopic repair of primary perineal hernias: the approach of choice in the 21st century

Perineal hernias are rare and result from the herniation of a viscus through the pelvic floor. Symptomatic perineal hernias are repaired surgically, historically via an open perineal, abdominal or abdominoperineal approach. We describe laparoscopic repair of a primary perineal hernia with mesh using the transabdominal approach. We believe that for uncomplicated primary perineal hernias laparoscopic repair is technically feasible, and associated with rapid recovery and minimal complications.     

Giant inguinal hernia: Report of a case and reviews of surgical techniques

INTRODUCTION

Inguinal hernia is one of the most surgical common diseases. Giant inguinal hernia is more unusual and significantly challenging in terms of surgical management. It is defined as an inguinal hernia that extends below the midpoint of inner thigh when the patient is in standing position.

PRESENTATION OF CASE

A 67-year-old male presented with giant right-side inguinal hernia with symptoms of partial colonic obstruction and significant weight loss. Barium enema revealed ascending colon, cecum and ileum contained in hernia sac without significant lesions of large bowel. He underwent hernia repair with omentectomy. Hernioplasty with polypropylene mesh was performed without any complications. He recovered uneventfully.

DISCUSSION

There were several repair techniques suggested by published articles such as resection of the content and increased intraabdominal volume procedure. Many key factors for management of the giant inquinal hernia were discussed. A new classification of the giant inquinal hernia was described.

CONCLUSION

Surgical repair for the giant inquinal hernia is challenging and correlated with significant morbidity and mortality due to increased intra-abdominal pressure.     

Inguinal hernioplasty with the Prolene Hernia System

Most tension-free hernia repair techniques achieve 0.1%–0.4% recurrence rates in patients with primary hernias. Currently, the Lichtenstein technique is considered to be the criterion standard. The Prolene Hernia System (PHS) is a recently introduced hernia-repair device that combines three proven mechanisms of action. We retrospectively reviewed early and late complications in 250 patients who underwent inguinal hernioplasties—125 performed with the Lichtenstein technique and 125 performed with the PHS—from March 1998–October 2002. Patients who underwent Lichtenstein hernia repair had nine complications, and those who underwent PHS surgery had only two; none of the complications were serious. Older male patients who underwent Lichtenstein hernia repair were more likely to have complications (P=0.04). One patient in the Lichtenstein group had a recurrence of his hernia, but there were no recurrences in the PHS group. In conclusion, the results of inguinal hernioplasties performed with the PHS are comparable to those achieved with Lichtenstein hernia repair, the criterion standard technique.