scholarly journals An incarcerated Spigelian hernia with the appendix in the sac passing though all layers of the abdominal wall: an unusual cause for chronic right iliac fossa pain

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Daniel Page ◽  
Rasika Hendahewa
Keyword(s):  
Chronic Pain ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Iliac Fossa ◽  
Spigelian Hernia ◽  
Transversus Abdominis ◽  
Abdominal Hernias ◽  
Right Iliac Fossa Pain ◽  
Pass Through ◽  
Internal Oblique

ABSTRACT Abdominal wall hernias are a common pathology and source of morbidity including chronic pain. They occur in various anatomical areas; amongst the rarest locations is the Spigelian hernia accounting for <2% of all abdominal hernias. We present a case report of a patient with chronic right iliac fossa pain caused by an incarcerated Spigelian hernia containing her appendix within the hernial defect. Rarer still is that her hernial defect penetrated all three layers of anterior abdominal wall, typically a Spigelian hernia would only pass through transversus abdominis and internal oblique layers.

scholarly journals An unusual case of right iliac fossa lump-spigelian hernia: a case report

2021 ◽  
Vol 9 (1) ◽  
pp. 239
Author(s):  
Birma Ram ◽  
Manoj Gopinath ◽  
Saroj Chaudhary ◽  
Desymol Johnson
Keyword(s):  
Case Report ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Abdominal Wall ◽  
Preoperative Diagnosis ◽  
Unusual Case ◽  
Surgical Repair ◽  
Anterior Abdominal Wall ◽  
Iliac Fossa ◽  
Spigelian Hernia

Spigelian hernia is a relatively uncommon hernia of anterior abdominal wall, occurring in different anatomical tissue planes. It is a variant of inter-parietal hernia. Preoperative diagnosis of obstructed inter-parietal hernia is based on imaging. Once correctly diagnosed it is easily amenable to surgical repair. We present a case of Spigelian hernia presenting as right iliac fossa lump with features of small bowel obstruction.

scholarly journals Abdominal wall ectopic testis torsion mimicking a Spigelian hernia in an adult

2017 ◽  
Vol 99 (2) ◽  
pp. e65-e68 ◽  
Author(s):  
M Natarajan ◽  
HM Alnajjar ◽  
CI Woodward ◽  
M Tshuma ◽  
T Marshall ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Iliac Fossa ◽  
Rare Condition ◽  
Spigelian Hernia ◽  
Oblique Muscle ◽  
Ectopic Testis ◽  
First Case ◽  
Testis Torsion ◽  
Right Iliac Fossa Pain ◽  
External Oblique

We report an unusual case of an ectopic testis identified in a 37-year-old man presenting with acute severe right iliac fossa pain and an irreducible mass. Initially diagnosed as a Spigelian hernia, computed tomography and ultrasonography identified the presence of an ectopic testis in the abdominal wall. Interparietal testicular ectopia is an extremely rare condition. We present and discuss the first case in the literature of an ectopic testis located between the internal and external oblique muscle layers of the anterior abdominal wall in an adult.

Concomitant Anterior and Posterior Component Separations: Absolutely Contraindicated?

2020 ◽  
pp. 155335062091419
Author(s):  
Jorge Daes ◽  
Joshua S. Winder ◽  
Eric M. Pauli
Keyword(s):  
Abdominal Wall ◽  
Lateral Displacement ◽  
Abdominal Wall Reconstruction ◽  
Component Separation ◽  
Transversus Abdominis ◽  
Lateral Abdominal Wall ◽  
Computed Tomography Images ◽  
Fresh Cadaver ◽  
Semilunar Line ◽  
Internal Oblique

Many experts in abdominal wall reconstruction believe that the combination of simultaneous ipsilateral anterior component separation (ACS) and posterior component separation (PCS) is contraindicated. We performed ipsilateral endoscopic ACS and either endoscopic or open PCS-transversus abdominis release (TAR) in 5 fresh cadaver models. The full length of the semilunar line and the lateral abdominal wall remained well reinforced by 2 complete layers, comprising the internal oblique (IO) and TA muscles and their investing fasciae. Myofascial releases occurred 4 cm (median) apart. Additionally, we reviewed computed tomography images at 1 month and 1 year after PCS-TAR in 17 patients (30 PCS-TARs). Lateral displacement of the TA relative to the rectus abdominis (RA) was significant only at the superior mesenteric artery level, where it was <1 cm (median). Muscle mass changed minimally over time. Several studies showed that abdominal wall reconstruction after PCS-TAR results in compensatory muscular hypertrophy of the RA, external oblique (EO), and IO muscles and provides better quality of life and improved core physiology. These changes did not occur when the midline was not restored. Theoretically, endoscopic ACS-EO may be added to PCS-TAR to avoid partially bridged mesh repair in patients in whom complete midline restoration is impossible via PCS-TAR alone. Nevertheless, we advise most surgeons to perform a small-bridged repair instead of risking increased morbidity by attempting a highly complicated procedure.

scholarly journals Surface electromyography comparison of the abdominal hypopressive gymnastics against the prone bridge exercise

2019 ◽  
Vol 12 (3) ◽  
pp. 243-246
Author(s):  
Gonzalo Alfonso Quiroz Sandoval ◽  
Nathalie Tabilo ◽  
Cristóbal Bahamondes ◽  
Pilar Bralic
Keyword(s):  
Abdominal Wall ◽  
Muscle Activity ◽  
Surface Electromyography ◽  
Healthy Subjects ◽  
Muscle Activation ◽  
Transversus Abdominis ◽  
Abdominal Pressure ◽  
Abdominal Muscles ◽  
External Oblique ◽  
Internal Oblique

Objectives: Abdominal hypopressive gymnastics (AHG) is a little-researched method designed to train the muscles of the abdominal wall and pelvic floor under low stress. This study’s objective is to compare levels of muscle activation in AHG against prone bridge by surface electromyography (sEMG) of the abdominal wall muscles. Methods: Twenty healthy subjects were enrolled to measure the muscle activity of the rectus abdominis (RA), transversus abdominis/internal oblique (Tra/IO), and external oblique (EO) during three exercises: prone bridge (PB), orthostatic hypopressive (OH), and hypopressive bridge (HB). Root mean square values normalized to the PB (%PB) as a baseline were used to compare the PB against OH and HB. Results: The median PB ratio (%PB) for the Tra/IO showed –10.31% and +59.7% activation during OH and the HB, respectively, whereas the RA showed –77.8% and +19.3% and the EO –39.8% and +9.8%. Significant differences were found for all muscles except the Tra/IO during the OH. Conclusion: This study’s results suggest that hypopressive exercises facilitate the activation of the Tra/IO similar to bridge exercises while simultaneously reducing RA and EO activity. This suggests that hypopressive training is a valid alternative for activating the abdominal muscles, isolating the Tra/IO at low intra-abdominal pressure.

scholarly journals 956 Retained Appendiceal Tip and Abdominal Wall Appendicolith - A Rare Combination of Post Appendicectomy Complications

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Dey ◽  
N Symons
Keyword(s):  
Abdominal Wall ◽  
Iliac Fossa ◽  
Symptomatic Relief ◽  
Radiological Investigation ◽  
Complete Excision ◽  
Rare Combination ◽  
Abdominal Wall Abscess ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Inflammatory Changes

Abstract Appendicitis involving the appendix stump is a recognised post appendicectomy complication but the same involving the appendiceal tip is rare. Similarly, abdominal wall abscess secondary to retained appendicolith is also infrequently encountered. Our case highlights a rare combination of both complications arising separately. A 29-year-old man presented with 3 days of generalised malaise and progressively worsening right iliac fossa pain some ten months after a laparoscopic appendicectomy. This had been complicated by residual right iliac fossa inflammation that was treated conservatively and serial scans demonstrated gradually resolving inflammation. He also had well controlled ulcerative colitis. On examination, he was noted to be pyrexial with a tender fluctuant mass in the right flank. An ultrasound scan demonstrated inflammatory changes in the abdominal wall with no intra-abdominal collections. A diagnostic laparoscopy found an inflamed appendix tip, attached to the residual mesoappendix and embedded in the abdominal wall behind the mid-ascending colon. A completion appendicectomy was performed. The patient recovered well but returned 4 months later with persistent pain and a fluctuant mass over the right iliac fossa. Radiological investigation revealed an abdominal wall collection containing a calcified appendicolith. The collection was refractory to ultrasound guided drainage and an exploration of the abdominal wall allowed extraction of the appendicolith followed by symptomatic relief. This case emphasizes the importance of complete excision of the appendix and extraction of debris, which can be challenging when the appendix lies in a retro-colic position.

scholarly journals COMPARISON OF ROPIVACAINE AND BUPIVACAINE IN ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING LAPAROSCOPIC SURGERY

2021 ◽  
pp. 4-5
Author(s):  
Patel Bhargavkumar Rameshbhai ◽  
Kansagra Meetkumar Dhirajlal
Keyword(s):  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Sensory Blockade ◽  
Analgesic Technique ◽  
Transversus Abdominis Muscle

Transversus Abdominis Plane (TAP) Block is a regional analgesic technique. It provides analgesia after abdominal surgery.The anterior abdominal wall is innervated by nerve afferents that course through the transverses abdominis neurovascular fascial plane. TAP block allows sensory blockade of abdominal wall skin and muscles when local anesthetic deposited above transversus abdominis muscle (TAM).

scholarly journals Electrical function of the abdominal muscles after combined plastic of extensive median hernias in the context of connective tissue dysplasia

2019 ◽  
Vol 12 (3) ◽  
pp. 152-157
Author(s):  
Radu Railianu
Keyword(s):  
Connective Tissue ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Clinical Signs ◽  
Clinical Severity ◽  
Abdominal Muscles ◽  
Abdominal Hernias ◽  
Connective Tissue Dysplasia ◽  
Optimal Rehabilitation ◽  
Relaxing Effect

Relevance. Improving the electrical function of abdominal muscles in patients with extensive median hernias of the anterior abdominal wall can be facilitated by optimizing the choice of methods for combined hernioplasty, taking into account the clinical severity of connective tissue dysplasia among the hernia carriers. Objective. Study the electrical function of abdominal muscles after the methods of combined hernioplasty of extensive median hernias, taking into account the severity of connective tissue dysplasia among the hernia carriers. Results.  The average numbers of electromyogram frequencies of the abdominal muscles of patients with extensive median hernias from the group without clinical signs of connective tissue dysplasia were almost the same after all the applied methods of combined hernioplasty. The predominance of the rectus muscles electric function over the lateral abdominal muscles among the patients of this group was 33,5 %. Electrofunctional rehabilitation of the abdominal muscles of patients in the second group of examinations depended on the method of combined hernioplasty and changed in the event of an increase or decrease in the severity of connective tissue dysplasia.  The recovery of electroactivity of abdominal muscles in the postoperative period in patients from the second group was more significant with an increase in the number of abdominal muscles applied to aponeuroses and vagina of relaxing sections, which contributed to an increase in mobility and contractility of the musculoaponeurotic layers of the anterior abdominal wall. Conclusions. Thus, with an increase in the severity of connective tissue dysplasia in patients with extensive median abdominal hernias, the method of combined hernioplasty with the most pronounced relaxing effect in relation to the anterior abdominal wall promoted optimal rehabilitation of abdominal muscles.

scholarly journals Posterior Components Separation With Transversus Abdominis Release (TAR) Versus Alternative Techniques of Components Separation: Systematic Review

2018 ◽  
Vol 103 (7-8) ◽  
pp. 355-365
Author(s):  
Aseel Sleiwah ◽  
Sandra McAllister
Keyword(s):  
Abdominal Wall ◽  
Primary Repair ◽  
Abdominal Wall Reconstruction ◽  
Hernia Recurrence ◽  
Transversus Abdominis ◽  
Wound Complications ◽  
Cochrane Central Register ◽  
Components Separation ◽  
Abdominal Hernias ◽  
Wall Components

The aim of this study is to assess the clinical effectiveness of posterior abdominal wall components separation with transversus abdominis muscle release (PCS-TAR) in the management of ventral abdominal hernias. Ventral abdominal hernias complicate up to 11% of laparotomy wounds. Surgical management includes primary repair, hernioplasty, flaps, and components separation. A technique has been described to close large abdominal defects by releasing bilateral myofascial flaps of rectus abdominis from external oblique and advancing these flaps to the midline. Minimally invasive and endoscopic techniques were subsequently developed to reduce complications. A recently described method is PCS-TAR. The hypothesis is that PCS-TAR for abdominal wall reconstruction is associated with lower rates of wound complications and hernia recurrence than other components separation techniques. A comprehensive search of databases including Medline, Embase, Cochrane Central Register of Controlled Trials, and Scopus was conducted in accordance with PRISMA guidelines, looking for the primary outcomes of hernia recurrence and wound complications following different techniques of components separation. Inclusion and exclusion criteria were defined. The quality of studies was examined independently by 2 assessors. A total of 363 studies were identified. Three retrospective comparative studies met the inclusion criteria. No randomized control trial comparing different techniques of abdominal wall components separation was identified. No technique could be identified as superior to others, due to a paucity of the literature. However, based on a few retrospective cohort studies, PCS-TAR emerges as a well-tolerated new technique, with a low incidence of wound complications and hernia recurrence.

scholarly journals Proprioceptive Stabilizer™ training of the abdominal wall muscles in healthy subjects: a quasi-experimental study

2018 ◽  
Vol 64 (12) ◽  
pp. 1134-1138
Author(s):  
Carlos Romero Morales ◽  
David Rodríguez Sanz ◽  
Mónica de la Cueva Reguera ◽  
Silvia Fernández Martínez ◽  
Patricia Téllez González ◽  
...  
Keyword(s):  
Experimental Study ◽  
Abdominal Wall ◽  
Healthy Subjects ◽  
Transversus Abdominis ◽  
Ultrasound Images ◽  
Low Back ◽  
Thickness Increase ◽  
Quasi Experimental ◽  
Imagej Software ◽  
Internal Oblique

SUMMARY The present quasi-experimental study aimed to assess the transversus abdominis (TrA), internal oblique (IO) and external oblique (EO) thickness in healthy subjects with the proprioceptive Stabilizer™ training in abdominal wall muscles. A sample of 41 healthy participants (age: 31.9 ± 4.5 y; height: 1.7 ± 0.1 m; weight: 68.3 ± 13.1 kg; body mass index, BMI: 22.9 ± 2.7 kg/m2) were recruited to participate in this study. Ultrasound images of the EO, IO, TrA, rectus anterior (RA) and interrecti distance (IRD) were measured and analyzed by the ImageJ software. Measurements were made at rest and during the abdominal drawing-maneuver (ADIM) developed by the patients with the Stabilizer™ located in the low back holding 40 mmHg for 10 seconds with a visual stimulus provided by a circular pressure marker. Ultrasound measurements for the abdominal wall muscles showed statistically significant differences (Π < .05) for a thickness decrease of the EO, IO and a thickness increase of TrA. A proprioceptive Stabilizer™ training produced a thickness increase in TrA muscle and a thickness decrease in EO and IO muscles in healthy subjects. These findings suggest that a proprioceptive Stabilizer™ training could be useful in individuals with low back pain and lumbopelvic pain.

scholarly journals Computed tomographic colonography: Diagnosis of an incarcerated Spigelian hernia

2014 ◽  
Vol 18 (1) ◽  
Author(s):  
Joel H. Bortz
Keyword(s):  
Small Bowel ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Abdominal Wall Hernia ◽  
Abdominal Discomfort ◽  
Spigelian Hernia ◽  
Computed Tomographic Colonography ◽  
Rare Form ◽  
Lateral Deviation ◽  
Computed Tomographic

A 68-year-old obese man underwent computed tomographic colonography (CTC) scanning to investigate worsening constipation and lower abdominal discomfort on his left side.Optical colonoscopy was contraindicated because of his comorbidities. A preliminary CTC diagnosis of incarcerated Spigelian hernia was made, based on lateral deviation of thesigmoid colon to the left as well as extrinsic impressions on it, and the central location of the small bowel. Spigelian hernia is a rare form of anterior abdominal wall hernia. CTC can play a role in its diagnosis.

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