Postherpetic abdominal pseudohernia: A diagnostic pitfall

Abstract

The accurate diagnosis of postherpetic abdominal pseudohernia, the rare complication of herpes zoster, is essential to avoid unnecessary imaging studies or surgery. Close observation and waiting for complete recovery are warranted considering the disease's self‐resolving nature and favorable prognosis.

Postherpetic abdominal pseudohernia. Presentation of a clinical case and literature review

“…This condition is often described regarding middle‐aged and elderly patients compromising the area around the T10–T12 dermatomes, like in our patient′s case. The ratio of men to women is approximately 4 : 1 with no differences between left or right sides …”

“…For its diagnosis, physicians should be aware of the history of cutaneous HZ manifestations in the anatomical region involved, and physical examination must denote the bulging of the abdominal wall corresponding to the paralysis of the musculature in the said location . It should be mentioned that, although in our case there was no visceral involvement, it can often be found together with soft tissue compromise.…”

“…It may coincide with vesicular eruption or occur shortly after its resolution . It is a benign entity that resolves ad integrum during the first year in 55–75% of the cases; that is, the remaining percentage of cases partially recover or never do . In these cases, there exist conservative measures, including mechanical support with a corset, adequate analgesia, and physical therapy to offer patients symptomatic improvement …”

Painful Abdominal Outpouching in an Adult Male

“…PHAP is a rare complication of HZ associated with segmental zoster paresis. Patients with this condition may exhibit bulging asymmetry of the abdomen, a reducible mass of the abdomen, or diminished or absent abdominal reflexes in the context of recent HZ [2][3][4][5][6].…”

“…Post-herpetic abdominal pseudohernia (PHAP), first described in 1896, is the result of weakness to the abdominal wall by segmental zoster paresis of the abdominal muscles. It is found in about 2% of all patients diagnosed with HZ, although estimates range [2,4,5]. We describe the case of an adult male diagnosed with HZ who later developed an abdominal outpouching determined to be PHAP.…”