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      Anterior Hepatic Herniation: An Unusual Presentation of Abdominal Incisional Hernia

      case-report
      Author(s): 1 , , 2 , 3 , 4
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: ventral hernia, hepatic herniation, liver herniation, budd chiari syndrome, steatosis

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          Abstract

          Hepatic herniation through an abdominal incisional hernia is a rare phenomenon that has been seldom reported in the medical literature. When present, this may cause patients significant distress and is associated with complications such as hepatic encephalopathy and Budd-Chiari syndrome. Most cases can be managed conservatively through observation, but many cases require surgical intervention to preserve hepatic function. Our case consists of a 54-year-old man who presented with asymptomatic herniation of the left hepatic lobe through an abdominal incisional hernia.

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          Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality

          Wellington Andraus, Rafael Soares Pinheiro, Quirino Lai … (2015)
          Background Patients with cirrhosis have a high incidence of abdominal wall hernias and carry an elevated perioperative morbidity and mortality. The optimal surgical management strategy as well as timing of abdominal hernia repair remains controversial. Methods A cohort study of 67 cirrhotic patients who underwent hernia repair during the period of January 1998-December 2009 at the University Hospital of Sao Paulo were included. After meeting study criteria, a total of 56 patients who underwent 61 surgeries were included in the final analysis. Patient characteristics, morbidity (Clavien score), mortality, Child-Turcotte-Pugh score, MELD score, use of prosthetic material, and elective or emergency surgery have been analysed with regards to morbidity and 30-day mortality. Results The median MELD score of the patient population was 14 (range: 6 to 24). Emergency surgery was performed in 34 patients because of ruptured hernia (n = 13), incarceration (n = 10), strangulation (n = 4), and skin necrosis or ulceration (n = 7). Elective surgery was performed in 27 cases. After a multivariable analysis, emergency surgery (OR 7.31; p 0.017) and Child-Pugh C (OR 4.54; p 0.037) were risk factors for major complications. Moreover, emergency surgery was a unique independent risk factor for 30-day mortality (OR 10.83; p 0.028). Conclusions Higher morbidity and mortality are associated with emergency surgery in advanced cirrhotic patients. Therefore, using cirrhosis as a contraindication for hernia repair in all patients may be reconsidered in the future, especially after controlling ascites and in those patients with hernias that are becoming symptomatic or show signs of possible skin necrosis and rupture. Future prospective randomized studies are needed to confirm this surgical strategy.
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            Incarceration of the hepatic lobe in incisional hernia: A case report

            Huseyin Eken, Arda Isik, Sercan Buyukakincak … (2015)
            Introduction Incisional hernias are abnormal peritoneal outward pouch-like protrusions that develop due to defects that arise as a result of the disruption of the fascia's continuity after abdominal surgery. Presentation of case A 77-year-old female patient presented to the emergency department of our hospital with complaints of abdominal swelling, abdominal pain, nausea and vomiting. The patient was recommended for surgery. It was decided that the primary fascia closure and onlay patch was the most appropriate approach. Discussion When the defect in the abdominal wall grows, the functionality of the related abdominal wall is disrupted thereby eliminating the dynamic structure of the abdominal wall. Incisional hernias lead to a significant number of job losses and morbidity and negatively affect quality of life. Moreover, the formations in the hernia pouch might lead to higher risk of strangulation and dysfunction. Conclusion Subcutaneous herniation of the left lobe of the liver passing through the abdominal wall is a very rare condition.
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              Traumatic handlebar hernia associated with hepatic herniation: a case report and review of the literature.

              Nikhil Talwar, Madhu Natrajan, Surender Kumar … (2007)
              A traumatic abdominal wall hernia (TAWH) is a rare type of hernia that occurs after blunt trauma to the abdomen. TAWH caused by direct trauma from bicycle handlebars is even more rare with fewer than 30 cases having being reported. Recognition of these hernias is important, because they may be associated with significant intrabdominal injuries. Despite an overall increase in incidence of blunt abdominal trauma, cases of TAWH remain rare, probably because of elasticity of the abdominal wall resists the shear forces generated by a traumatic impact. A high level of clinical suspicion is required for diagnosis of TAWH in patients with handlebar injuries. We present the case of a 20-year-old man with a traumatic handlebar hernia associated with herniation of the liver and hepatic ductal injury, which was managed successfully by a delayed repair of the hernia.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 13 February 2019
                Publication date (Electronic, collection): February 2019
                Volume: 11
                Issue: 2
                Electronic Location Identifier: e4066
                Affiliations
                [1 ] Internal Medicine, Saint Barnabas Hospital, Bronx, USA
                [2 ] Gastroenterology, Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital, Brooklyn, USA
                [3 ] Gastroentrology, Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital, Brooklyn, USA
                [4 ] Gastroenterology and Hepatology, Saint Barnabas Hospital, Bronx, USA
                Author notes
                Article
                DOI: 10.7759/cureus.4066
                PMC ID: 6464280
                SO-VID: 121daf07-4de5-4a49-948b-8834750d8c83
                Copyright © Copyright © 2019, Then et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 4 February 2019
                Date accepted : 13 February 2019
                Categories
                Subject: Internal Medicine
                Subject: Gastroenterology
                Subject: General Surgery

                Keywords: ventral hernia,hepatic herniation,liver herniation,budd chiari syndrome,steatosis
                Data availability:
                Keywords: ventral hernia, hepatic herniation, liver herniation, budd chiari syndrome, steatosis

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