A ventral incisional hernia with herniation of the left hepatic lobe and review of the literature

Abstract

SUMMARYVentral incisional hernias with hepatic herniation are extremely rare. Only six cases have been reported so far in the literature. We report a case of a ventral incisional hernia with hepatic herniation along with a review of the literature. A 70-year-old female patient with a history of coronary artery bypass graft surgery 6 months earlier, was admitted to our hospital with symptoms of epigastric swelling and discomfort for 3 months. On examination, she had a mild tender 5 cm×5 cm epigastric lump and was diagnosed as ventral incisional hernia. Contrast-enhanced CT of the abdomen revealed a ventral hernia with herniation of omentum and left hepatic lobe. The patient underwent onlay mesh repair and is asymptomatic at 1-month follow-up. There is a need for evaluation of risk factors for this type of ventral incisional hernia and to recognise it as a special entity. BACKGROUND

Volvulus of the Transverse Colon Herniated Through Drain Site

“…Hernias at previous surgical incisions are referred to as incisional hernias. Almost 3% to 11% of the patients who underwent abdominal surgery will develop an incisional hernia [ 3 , 4 ]. Hernias occurring through the previous surgical drain site are also known to occur and are usually considered a type of incisional hernia [ 2 ].…”

“…Multiple risk factors for incisional hernias are well recognized, such as obesity, poor nutrition, infection at the drain site, old age, and increased intra-abdominal pressure due to various causes like a chronic cough [ 3 ]. Risk factors for the development of transverse colon volvulus include redundancy and non-fixation of the colon, previous volvulus, distal colonic obstruction, adhesions, malposition of the colon during previous surgery, mobility of the right colon, inflammatory strictures and carcinoma, chronic constipation, Clostridium difficile associated pseudomembranous colitis and impaired intestinal motility in pregnancy [ 6 , 7 ].…”

Anterior Hepatic Herniation: An Unusual Presentation of Abdominal Incisional Hernia

“…Epidemiologic data are not available on hepatic herniation through the abdominal wall due to its rarity. Reported cases have occurred in association with abdominal incisional hernias, nonalcoholic steatohepatitis, coronary artery bypass grafting (CABG), or direct trauma to the abdomen [5-6].…”

Unusual case of ventral liver herniation

“…Neelamraju Lakshmi et al . reported seven cases, all without strangulation, four of which followed sternotomy.…”

“…Ventral liver herniation is rare and most commonly known causes include congenital diaphragmatic herniation or omphalocele and traumatic hernias . Rarer causes include ventral incisional hernias with hepatomegaly from non‐alcoholic steatohepatitis, hepatomegaly from recurrent steatosis post‐transplant (causing herniation via rectus sheath), post sternal wound reconstruction or sternotomy and post open cholecystectomy or laparotomy . Risk factors include obesity, old age, poor nutrition, site infection and increased intra‐abdominal pressure …”