The linea arcuata hernia: a report of two cases

Two male patients presented to the surgical outpatient clinic with a paramedian abdominal bulge. In the first patient, the hardly known diagnosis linea arcuata hernia (LAH) had been missed at a previous exploration 8 years ago. In the second patient, pre-operative imaging showed an abdominal wall hernia. Diagnostic laparoscopy revealed an LAH. In both cases, the hernia was repaired with a mesh graft.     

腹腔镜下腹腔内补片植入术治疗腹白线疝可行性分析

目的探讨腹腔镜下治疗腹白线疝可行性及安全性。 方法回顾性分析2015年1月至2016年10月,首都医科大学附属北京朝阳医院收治的20例腹白线疝患者,术前均诊断明确,于全麻气管插管下行腹腔镜下腹腔内补片植入术（Intraperitoneal Onlay Mesh,IPOM）。对患者的手术时间、术中出血量、中转开腹情况、补片使用情况、住院时间、术后并发症进行分析。 结果20例腹白线疝患者均在腹腔镜下成功完成手术,无中转开腹病例,平均手术时间（45.5±21.5）min,术中出血量少、平均（5.78±4.07）ml,术中均放置腹腔内专用防粘连补片,住院时间短、平均（8.65±3.31）d,术后均治愈出院,随访4～25个月,无一例发生补片感染、长期慢性疼痛、肠梗阻、疝复发等严重并发症。 结论腹腔镜下IPOM术治疗腹白线疝安全、可行,疗效可靠。     

Symptomatic retrosternal (Morgagni) hernia

Three patients with Morgagni's hernia are described. The presenting symptoms in the first patient were retrosternal pressure, dyspnea, and cough; in the second, precordial pain and pressure in the left side of the chest; in the third, vomiting and recurrent respirator infections. Surgical repair via an abdominal approach led to the disappearance of symptoms in all three patients.The low reported incidence of this type of hernia may be due to the fact that asymptomatic cases are not diagnosed, and others may not be diagnosed radiologically because of difficulties in interpreting opacities in the cardiophrenic angle.     

Symptomatic Bochdalek hernia in an octogenarian

We present a case of an 88-year-old man who presented with chest pain and shortness of breath. Chest radiography suggested the presence of a ruptured diaphragm, and on exploration a left Bochdalek defect with herniation of stomach and small bowel into the left pleural cavity was found. This was repaired and the patient eventually was discharged to a nursing facility. We believe this represents the oldest patient presentation of a symptomatic Bochdalek hernia.     

Symptomatic hernia. Strangulated hernia combined with acute abdominal disease

Strangulation of a previously unknown or asymptomatic hernia may be caused by acute abdominal disease. If the presence of such a disease is not recognized, it will result in high morbidity and mortality. Five cases are presented. In only one was the correct diagnosis of acute abdominal disease made preoperatively. In three cases, the correct diagnosis was made only during hernial repair. In one case, an umbilical hernia became strangulated soon after laparotomy for a periappendiceal abscess. Three of the five cases were complicated by severe wound infection. Preoperative diagnosis is difficult because clinical and laboratory findings are frequently similar in both conditions. A strangulated hernia, especially one which was previously unrecognized and asymptomatic, should raise the suspicion of an underlying acute abdominal disease. Careful evaluation of the patient's history, physical and laboratory findings as well as of the situation during surgery will enhance the possibility of correctly diagnosing this condition, thus reducing both morbidity and mortality.     

高频彩色多普勒超声在白线疝诊断中的应用

目的探讨研究高频彩色多普勒超声在白线疝诊断中的应用价值。 方法回顾性分析2007年1月至2014年12月解放军总医院24例经外科手术证实为白线疝患者的临床资料和声像图表现。 结果术前高频彩色多普勒超声检查发现,疝的发生部位均位于剑突与脐孔之间的腹壁中线处,腹白线缺损处（疝环）直径0.4～2.8 cm,疝囊大小（1.1 cm×0.3 cm×1.0 cm）～（8.0 cm×3.1 cm×7.2 cm）,疝囊形态多不规则,疝囊内回声因内容物不同而表现不同,主要分为3类,第1类内容物为腹膜外脂肪,声像图表现为较均匀或不均匀的低回声,第2类内容物主要为网膜,声像图表现为中等稍低回声,第3类内容物主要为肠管,声像图表现为疝囊内可见肠管样回声,动态观察并可见其蠕动。 结论高频彩色多普勒超声可以清楚地显示腹白线的连续性情况、测量缺损的直径、疝囊的大小、判断疝的内容物以及有无嵌顿疝等情况,并具备无损伤、廉价、可重复性好、可动态观察等优势,对于白线疝的诊断有很好的敏感性和特异性,因此对白线疝的临床诊断具有非常重要的价值。     

Symptomatic gastric involvement in a parastomal hernia: uncommon presentation

Abstract

Introduction: A parastomal hernia (PSH) is the most common complication of a stoma creation. The PSH contents normally consist of mobile abdominal structures, i.e. omentum and small or large bowel loops. A herniated stomach is thereby very rare, given that only eight cases are reported in the literature.

Patients and methods: Two female patients with clinical symptoms of gastric involvement in a PSH were admitted in our centre.

Results: Computed tomography (CT) imaging, nasogastric decompression and an efficient operative intervention ensured a good clinical outcome in both patients, but with a long hospital stay and temporary gastroparesis in one patient. Regarding our two cases and the eight cases reported in the literature, mainly older females with colostomies are at risk and most of them need surgery.

Conclusions: In patients presenting with obstructive symptoms, one should be aware of a possible gastric outlet obstruction because of its involvement in a PSH, although sporadic. Surgery might be considered as the treatment of choice because conservative treatment mostly fails. Earlier surgery might perhaps also reduce postoperative hospital stay and gastroparesis.     

Symptomatic port-site hernia associated with a non-bladed trocar after laparoscopic live-donor nephrectomy

We describe what appears to be the first case of a port-site hernia at the site of insertion of a 10-mm non-bladed trocar, which was discovered 4 days after laparoscopic live-donor nephrectomy. We now close all 10-mm port sites in adults and all 5-mm port sites in children; this can be done easily using the Carter-Thomason device.     

Symptomatic forearm muscle hernia: repair by autologous fascia lata inlay.

Eleven cases of symptomatic muscle hernias of the forearm requiring surgical intervention have been described previously. Pain on extremity exertion and an unaesthetic bulge of the forearm were the primary indications for surgery. Advocated treatment modalities range from forearm fasciotomy to anatomic repair of the fascial defect. Although fasciotomy relieves the narrow fascial constriction around the herniated muscle reliably, it often yields an unappealing forearm deformity and incomplete resolution of pain on extremity exertion. Anatomic repair provides the theoretical advantage of restoring normal muscle fascia relationships while concomitantly improving the aesthetic appearance of the extremity. The authors report a case of symptomatic forearm muscle herniation treated successfully with an autologous fascia lata inlay graft.     

Biomechanical and morphological types of the linea alba and its possible role in the pathogenesis of midline incisional hernia.

OBJECTIVE: To review the tensile strength of the different histological types of fibres in the linea alba and correlate the anatomical features of the anterior abdominal wall with the tensile strength of the linea alba to see whether the tensile strength of the linea alba might contribute to the development of midline incisional hernias. DESIGN: Laboratory study. SETTING: University hospital, Germany. SUBJECTS: 46 cadavers in part one, and 9 freshly frozen and 38 formalin-fixed cadavers in part two. INTERVENTIONS: In the first part of the study the histological examination was by binocular dissection microscopy, magnification x10, but this was not sufficiently reproducible so in the second part we used an Olympus BX50 microscope, magnification x20, and Optimas 5.22 picture processing software. Tensile strength was measured using a Loosenhausen ZHP 1-6 tensiometer. MAIN OUTCOME MEASURES: Correlation between anatomical features and tensile strength. RESULTS: The method used in part one of the study failed to differentiate between the three types of fibres in the linea alba (weak, intermediate, and compact). In the second part of the study we found that the fibres were irregular, with no systematic crossing of the fibres of the aponeurosis. There was a significant correlation between the thickness and density of fibres in the linea alba and its tensile strength (r = 0.9). The thickness of fibres ranged from 21.9-38.2 microm and the density from 48% to 90%. The tensile strength ranged from 3-25 kp. CONCLUSION: A combination of low density and thin fibres in the linea alba could be a predisposing factor for development of midline incisional hernias