1/17. Incarceration of umbilical hernia following transjugular intrahepatic portosystemic shunt for the treatment of ascites.Transjugular intrahepatic portosystemic shunt (TIPS) is an effective therapy for patients with medically refractory ascites. Many patients with refractory ascites have umbilical herniation. Incarceration of umbilical hernia has been reported following diuresis, paracentesis, and peritoneovenous shunting. We report 2 cases of umbilical hernia incarceration following resolution of ascites after TIPS.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
2/17. Omental herniation through a 3-mm umbilical trocar site: unmasking a hidden umbilical hernia.BACKGROUND: The incidence of umbilical hernia following laparoscopic surgery varies from 0.02-3.6%. The incidence of pre-existing fascial defects, however, may be as high as 18% in patients undergoing abdominal laparoscopic surgery. Previous recommendations have been made to close any fascial defect greater than or equal to 10 mm. Reported here is a case of herniation through a 3-mm trocar site incision and the discovery of a pre-existing fascial defect. CASE REPORT: A 32-year-old female underwent an uncomplicated laparoscopic tubal ligation using a 3-mm umbilical port. Prior to umbilical trocar removal at the completion of the case, the carbon dioxide was evacuated from the abdomen and the sleeve was withdrawn under direct vision. Neither the fascial nor skin incisions were sutured. On postoperative day two, the patient returned with omentum herniating from the 3-mm site. At surgery, a 1.5-cm pre-existing fascial defect was discovered adjacent to the trocar site. The hernia sac tracked laterally to the base of the umbilicus, and the omentum had slid into the sac and out the skin opening. CONCLUSION: As this report illustrates, herniation associated with laparoscopic trocar sites can occur with incisions as small as 3 mm. The presence of pre-existing fascial defects can cause increased morbidity in any laparoscopic surgery, and as illustrated in this report, may predispose the patient to site herniation. The detection and management of these defects is crucial in preventing postlaparoscopic complications.- - - - - - - - - - ranking = 7keywords = herniation (Clic here for more details about this article) |
3/17. Ovarian cancer presenting as umbilical hernia.Six patients are reported whose presenting symptom was umbilical herniation. Upon exploration of the umbilicus with the intent to repair the hernia, ovarian cancer and malignant ascites were encountered in each individual. Cancer at the umbilicus, both metastatic and primary, is briefly discussed. The apperance of an acquired umbilical hernia in an otherwise asymptomatic patient should raise the suspicion of intraabdominal malignancy.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
4/17. Cardiac diverticulum and omphalocele: Cantrell's pentalogy or syndrome.Omphaloceles and left ventricular diverticulums are rare disorders. Although either is known to occur on its own, the combination is highly suggestive of the so-called pentalogy of cantrell. This syndrome is a combination of deformities involving midline structures, with exteriorisation of the heart, or 'ectopia cordis', as the most severe malformation. A cause has yet to be identified, though genes located on the X-chromosome may be involved. We discuss a neonate who presented with an omphalocele and a palpable diverticulum of the left ventricle. An omphalocele, especially when above the umbilicus, is an indication for further investigation for deformities as seen in the spectrum of Cantrell's pentalogy, especially cardiac malformations and anterior diaphragmatic herniation. A left ventricular diverticulum is usually associated with Cantrell's syndrome. When found, it is usually accompanied by other intracardiac malformations, so that again further examination is indicated. In our patient, there was an atrial septal defect within the oval fossa, along with a ventricular septal defect and unobstructed albeit anomalous venous pulmonary return to the left atrium. Early surgical intervention seems to be indicated, as spontaneous rupture, arrhythmias, and thromobogenicity of the ventricular diverticulum have all been reported.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
5/17. Umbilical and bilateral inguinal hernias in a veteran powerlifter: is it a pressure-overload syndrome?Umbilical, inguinal and hiatal hernias are all thought to occur from basically the same etiology, a malformation in the tissue leading to herniation. The mechanisms for these malformations range from congenital to degenerative. Earlier studies proposed that hiatal hernias result from age-related degenerative changes in the phrenoesophageal ligament leading to subsequent herniation. We found that hiatal hernias occur in young power athletes secondary to intra-abdominal pressure overload of the phrenoesophageal ligament. We present a case of umbilical and bilateral inguinal hernias occurring in a veteran powerlifter. The pathogenesis of multiple hernias and the physiological pressure systems involved in the development of multiple hernias in a power athlete are discussed.- - - - - - - - - - ranking = 2keywords = herniation (Clic here for more details about this article) |
6/17. Herniation through the foramen of Winslow presenting as obstructive jaundice.Herniation through the foramen of Winslow is a rare variety of paraduodenal hernia. We report a 19-month-old child with obstructive jaundice due to midgut herniation through the foramen of Winslow with associated volvulus. The herniation and volvulus were precipitated by intestinal malrotation. The patient underwent extraamniotic silo repair of exomphalos major in the neonatal period. Investigation for malrotation is recommended after extraamniotic closure of exomphalos.- - - - - - - - - - ranking = 2keywords = herniation (Clic here for more details about this article) |
7/17. Three-dimensional first-trimester transvaginal diagnosis of alobar holoprosencephaly associated with omphalocele in a 46,XX fetus.A three-dimensional (3D) transvaginal diagnosis of alobar holoprosencephaly (HPE) with associated omphalocele is reported at 12 weeks, 3 days gestation. Diagnosis of HPE was based on visualization of a single holoprosencephalic cavity with absent falx and basal ganglia and omphalocele by the presence of abdominal wall defect with mid-gut herniation. Chorionic villus sampling showed a normal 46,XX karyotype. 3D volumetric reconstruction allowed a more detailed definition of the anatomic landmarks of the lesion, including visualization of a thin rim of cortical mantel within the prosencephalic cavity, the dysmorphic face with flattened nose, and the abdominal eventration that looked like an abdominal air bag on 3D volumetric reconstruction.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
8/17. Omental herniation through a 3-mm umbilical trocar site.omentum herniated through a 3-mm umbilical port site 6 days after laparoscopic exploration for a nonpalpable testicle in an 18-month-old boy. Fascial closure of even these small sites may be advisable.- - - - - - - - - - ranking = 4keywords = herniation (Clic here for more details about this article) |
9/17. Body stalk anomaly--a case report.A case is presented of an amnionic rupture sequence which led to massive fetal ventral herniation and lordoscoliosis. Characteristic ultrasonographic findings of an omphalocele, fetal attachment to the placenta, and the absence of free-floating umbilical cord were observed.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
10/17. prenatal diagnosis of a fetus with terminal deletion of chromosome 1 (q41)Many authors have suggested that individuals affected by a terminal 1q deletion display a phenotypically definable and recognizable syndrome. In all of the 27 cases reported to date, the breakpoints were at band q42 or distally to it. To our knowledge, we report the first case of a terminal 1q41 deletion. Diagnosis was made prenatally by amniocentesis, following ultrasonographic diagnosis of omphalocele, cerebral ventriculomegaly, and increased nuchal fold thickness in a 19-week female fetus. Multiple facial and extremity features were consistent with the proposed distal 1q deletion syndrome; omphalocele, however, has not been reported previously. The absence of liver herniation into the omphalocele sac in this case supports the previously reported association of this finding with chromosomal anomalies.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
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