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Transiliac hernia after bone graft
Journal of Visceral Surgery (2013) 150, 419—420
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SURGICAL IMAGES
Transiliac hernia after bone graft N. Kunin ∗, C.-H. Gancel , A. Foret , C. Gayet , J.-P. Letoquart , M. Daaboul Service de chirurgie viscérale et digestive, centre hospitalier intercommunal de Cornouaille, 14, avenue Yves-Thépot, 29000 Quimper, France
KEYWORDS Transiliac hernia; Bone harvesting; Hernia repair
Summary Lumbar hernias, namely transiliac hernias, are not frequent events and are almost always associated with bone graft harvesting from the iliac crest. We describe a case of transiliac hernia 10 years after bone graft harvest, the patient presenting with right colon incarceration. Diagnosis was made by CT scan. The hernia was repaired with a composite polypropylene-PTFE mesh (Bard® ). © 2013 Elsevier Masson SAS. All rights reserved.
Comments An 82-year woman complained of symptoms of low-grade intestinal obstruction. Her past medical history was extensive, including arterial hypertension, bilateral cataract operations, appendectomy, bilateral total knee replacement, abdominal aortic aneurysm treated by intra-arterial endoprosthesis, left ilio-femoral bypass, bilateral total hip replacement complicated by sepsis and requiring revisional surgery with bone graft taken from the right iliac crest. Abdominal CT scan confirmed the presence of a transiliac hernia with incarcerated right colon (Figs. 1 and 2). The patient underwent surgery on a semi-emergent basis: the McBurney scar was reopened, the hernia (sac and right colon) was reduced, and the sac was dissected and resected. A 5 × 5 cm defect in the iliac wing was found (Fig. 3). Repair was performed by apposition of a 10 × 15 cm composite polypropylene-PTFe (Bard® ) mesh affixed to the iliac and transverse muscles by resorbable tacks (Fig. 4). Her postoperative course was complicated by a parietal hematoma beneath the incision related to postoperative anticoagulation therapy, which required debridement under general anesthesia 48 h later. Her postoperative course was uneventful and she was able to go home after one week in hospital.
∗
Corresponding author. Tel.: +33 061 775 0173; fax: +33 029 917 7054. E-mail addresses: [email protected], [email protected] (N. Kunin).
1878-7886/$ — see front matter © 2013 Elsevier Masson SAS. All rights reserved. http://dx.doi.org/10.1016/j.jviscsurg.2013.09.007
420
N. Kunin et al.
Figure 1. Abdomino-pelvic CT scan, transverse slice: transiliac hernia containing the right colon (arrow).
Even though more than 300 cases of lumbar hernia have been described in the literature [1], only about 20 were secondary to bone graft harvesting, fracture or debridement for osteomyelitis [2]. Nonetheless, in a series of 59 iliac bone grafts, the incidence of this complication was 5% [3]. Onset of hernia is enhanced by increased intra-abdominal pressure and muscular atrophy. Early signs include soft tissue enlargement in the area corresponding to the iliac bone defect, associated with hydro-aeric bowel sounds at auscultation on the hernia. The risk of incarceration is evaluated at 25% and that of strangulation, 10% [4]. Abdomino-pelvic CT scan is the examination of choice for diagnosis. Several techniques have been used to repair the bone defect responsible for the appearance of lumbar hernia: mobilization of nearby tissues, such as the abdominal fascia and the iliac muscle, the Bosworth technique based on transposition of the anterosuperior iliac spine posteriorly to reimplant the abdominal fascia on the iliac crest, the Koontz technique, which uses the lumbar fascia, and lastly, the technique of Alexandre that makes use of a prosthesis
Figure 3. Intra-operative view: before hernia repair. 5 × 5 cm defect in the iliac ala (arrow).
Figure 4. Intra-operative view: after repair with 10 × 15 cm composite polypropylene-PTFe mesh.
fixed to the muscles and periosteum surrounding the hernia [1,2]. Laparoscopic mesh repair was reported in 1996 [1].
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.
References
Figure 2. surgery.
Diagram showing the bone defect created by orthopedic
[1] Yurcisin BM, Myers CJ, Stahlfeld KR, Means JR. Laparoscopic hernia repair following iliac crest harvest. Hernia 2010;14:93—6. [2] Juan-Garcia E, Canales V, Peguero A, Herrera A, Martinez A. Abdominal hernia through a defect in the iliac bone after resection of a chondrosarcoma of the pelvis. Acta Orthop Belg 2002;68(1):79—82. [3] Radais F, Facy O, Ortega-Deballon P. Transiliac hernia. Am J Surg 2011;201(6):e41—2. [4] D’Hondt S, Soysal S, Kirchhoff P, Oertli D, Heizmann O. Small bowel obstruction caused by an incarcerated hernia after iliac crest bone harvest. ISRN Surg 2011;2011:836568.
Available online at
ScienceDirect www.sciencedirect.com
SURGICAL IMAGES
Transiliac hernia after bone graft N. Kunin ∗, C.-H. Gancel , A. Foret , C. Gayet , J.-P. Letoquart , M. Daaboul Service de chirurgie viscérale et digestive, centre hospitalier intercommunal de Cornouaille, 14, avenue Yves-Thépot, 29000 Quimper, France
KEYWORDS Transiliac hernia; Bone harvesting; Hernia repair
Summary Lumbar hernias, namely transiliac hernias, are not frequent events and are almost always associated with bone graft harvesting from the iliac crest. We describe a case of transiliac hernia 10 years after bone graft harvest, the patient presenting with right colon incarceration. Diagnosis was made by CT scan. The hernia was repaired with a composite polypropylene-PTFE mesh (Bard® ). © 2013 Elsevier Masson SAS. All rights reserved.
Comments An 82-year woman complained of symptoms of low-grade intestinal obstruction. Her past medical history was extensive, including arterial hypertension, bilateral cataract operations, appendectomy, bilateral total knee replacement, abdominal aortic aneurysm treated by intra-arterial endoprosthesis, left ilio-femoral bypass, bilateral total hip replacement complicated by sepsis and requiring revisional surgery with bone graft taken from the right iliac crest. Abdominal CT scan confirmed the presence of a transiliac hernia with incarcerated right colon (Figs. 1 and 2). The patient underwent surgery on a semi-emergent basis: the McBurney scar was reopened, the hernia (sac and right colon) was reduced, and the sac was dissected and resected. A 5 × 5 cm defect in the iliac wing was found (Fig. 3). Repair was performed by apposition of a 10 × 15 cm composite polypropylene-PTFe (Bard® ) mesh affixed to the iliac and transverse muscles by resorbable tacks (Fig. 4). Her postoperative course was complicated by a parietal hematoma beneath the incision related to postoperative anticoagulation therapy, which required debridement under general anesthesia 48 h later. Her postoperative course was uneventful and she was able to go home after one week in hospital.
∗
Corresponding author. Tel.: +33 061 775 0173; fax: +33 029 917 7054. E-mail addresses: [email protected], [email protected] (N. Kunin).
1878-7886/$ — see front matter © 2013 Elsevier Masson SAS. All rights reserved. http://dx.doi.org/10.1016/j.jviscsurg.2013.09.007
420
N. Kunin et al.
Figure 1. Abdomino-pelvic CT scan, transverse slice: transiliac hernia containing the right colon (arrow).
Even though more than 300 cases of lumbar hernia have been described in the literature [1], only about 20 were secondary to bone graft harvesting, fracture or debridement for osteomyelitis [2]. Nonetheless, in a series of 59 iliac bone grafts, the incidence of this complication was 5% [3]. Onset of hernia is enhanced by increased intra-abdominal pressure and muscular atrophy. Early signs include soft tissue enlargement in the area corresponding to the iliac bone defect, associated with hydro-aeric bowel sounds at auscultation on the hernia. The risk of incarceration is evaluated at 25% and that of strangulation, 10% [4]. Abdomino-pelvic CT scan is the examination of choice for diagnosis. Several techniques have been used to repair the bone defect responsible for the appearance of lumbar hernia: mobilization of nearby tissues, such as the abdominal fascia and the iliac muscle, the Bosworth technique based on transposition of the anterosuperior iliac spine posteriorly to reimplant the abdominal fascia on the iliac crest, the Koontz technique, which uses the lumbar fascia, and lastly, the technique of Alexandre that makes use of a prosthesis
Figure 3. Intra-operative view: before hernia repair. 5 × 5 cm defect in the iliac ala (arrow).
Figure 4. Intra-operative view: after repair with 10 × 15 cm composite polypropylene-PTFe mesh.
fixed to the muscles and periosteum surrounding the hernia [1,2]. Laparoscopic mesh repair was reported in 1996 [1].
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.
References
Figure 2. surgery.
Diagram showing the bone defect created by orthopedic
[1] Yurcisin BM, Myers CJ, Stahlfeld KR, Means JR. Laparoscopic hernia repair following iliac crest harvest. Hernia 2010;14:93—6. [2] Juan-Garcia E, Canales V, Peguero A, Herrera A, Martinez A. Abdominal hernia through a defect in the iliac bone after resection of a chondrosarcoma of the pelvis. Acta Orthop Belg 2002;68(1):79—82. [3] Radais F, Facy O, Ortega-Deballon P. Transiliac hernia. Am J Surg 2011;201(6):e41—2. [4] D’Hondt S, Soysal S, Kirchhoff P, Oertli D, Heizmann O. Small bowel obstruction caused by an incarcerated hernia after iliac crest bone harvest. ISRN Surg 2011;2011:836568.