Rare Presentations of Hernias - Medical

Rare presentations of hernias

1. Rare presentations of hernias Randev A. Wannakuwatte

2. Overview Hernia surgery is one of the commonest procedures performed. Although the vast majority of hernias are typical on presentation, some present as rare types. This may pose a degree of difficulty in diagnosing and treating as the likelihood of encountering such hernias becomes a limiting factor with regards to experience during the average surgical career Clinical features of each type tend to be subtle and frequently overlapping, therefore a clear understanding of clinical features as well as supporting imaging information is critical for accurate diagnosis and treatment planning

3. Spigelian hernia Herniation occurs through the spigelian fascia which is comprised of the transversus abdominis and internal oblique aponeurosis Risk of incarceration and strangulation is high due to a small neck and lack of clinical features to suspect as such

4. Lumbar hernia Superior lumbar triangle bounded by the 12th rib, paraspinal muscles and the internal oblique muscle Inferior lumbar triangle bounded by the iliac crest, latissimus dorsi and external oblique muscle Patient may present with back pain or weakness of activities associated with use of these muscles Retroperitoneal contents generally found in hernial sack

5. Obturator hernia Herniation occurs through the osseous defect bounded by the pubic bone and the ischium which is usually covered by a membrane with fenestrations for the obturator neurovascular bundle Howship romberg sign may be present, but current diagnosis is mostly aided by CT

6. Sciatic hernia Herniation occurs through the greater sciatic foramen Bowel obstruction is generally the first symptom A tender lump may be felt on the gluteal region

7. Perineal hernia Herniation occurs through the perineum as a result of pelvic diaphragm weakness Commonly associated with abdominoperineal resection, vaginal hysterectomy and perineal prostatectomy