Fig 16 - uploaded by Bruno Coulier
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-CT anatomy of the inguinal area: these two coronal MDCT views (A, B) obtained in a 60 year old patient presenting with a left mild indirect inguinal hernia (IIH) illustrate the classical anatomic landmarks of the inguinal area. The femoral area (1)where a femoral hernia may produce medially to the femoral vessels (white arrowhead)-is separated from the inguinal area by the inguinal ligament (B, open arrow). The epigastric vessels (A, black arrow)-contained in the external umbilical fold separating the medial from the external inguinal fossa-represent the landmarks between the anatomic sites where direct (internal inguinal fossa =2) and indirect (external inguinal fossa = 3) hernias may produce. Rectus muscle = white star. Internal oblique muscle = white arrow.
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Thanks to its very high performances in term of spatial resolution, table speed and multiplanar reconstructions (MPR), 64-row MDCT today produces unrivalled high quality images of the entire abdominal wall (AW) during a single short breath hold. It appears thus particularly useful for the evaluation of AW hernias, allowing accurate identification o...
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Citations
... The Morgagni foramina, also known as sternocostal triangles or Larrey's triangles, are small anterior diaphragmatic defects in which the internal thoracic arteries course to become the superior epigastric arteries, along with associated veins and lymphatics [1]. Protrusion of viscus through these foramina results in Morgagni hernias (MHs). ...
... Adult patients are often asymptomatic, and these defects are often discovered incidentally during diagnostic workup or the intraoperative period [2]. In addition to MHs, hernia defects can also occur within the foramen of Bochdalek, which often occur along the posterolateral wall of the diaphragm [1]. Although more common than Morgagni defects, Bochdalek hernias often present with more severe symptoms such as acute respiratory distress, abdominal pain, and ileus [5]. ...
Morgagni hernia (MH) is a congenital diaphragmatic hernia that is often asymptomatic in adult patients. These defects may be discovered incidentally during the intraoperative period and repaired laparoscopically with tension-free synthetic mesh when surgery is warranted. Presently, there is a dearth of studies addressing incidental MH repair in the setting of concomitant bariatric surgery. As such, there are no clear guidelines as to whether or not asymptomatic hernias found incidentally during bariatric surgery require operative repair. Herein, we present the case of a morbidly obese female patient with an incidental Morgagni defect that was identified during an elective sleeve gastrectomy. We also reviewed the literature to assess the efficacy of concurrent bariatric surgery and hernia repair.
... Чаще в грыжах передней брюшной стенки хирург видит БС [38]. С одной стороны, это положительное явление -БС защищает петли кишечника от ущемления, тем самым беря удар на себя. ...
The interest of surgeons in the greater omentum is associated with a unique combination of such functions as plasticity, immune defense, barrier, hormonal, angiogenesis and regeneration for adjacent tissues, reabsorption, hemostatic, thermoregulation. The purpose of this review was to track the historically changing position of operations with the use of the greater omentum in abdominal, thoracic surgery, reconstructive plastic surgery, analyze the aspects of the use and controversial issues of omentization of the anastomoses line and omentoplasty in modern conditions, as well as highlight promising directions for the use of the greater omentum in medicine. in the sources of domestic and foreign databases until July 2021. Information about the negative consequences of omentectomy is given – a decrease in local and general immunoresistance, the development of adhesive disease, an increase in the number of postoperative purulent-inflammatory complications. It is useful for the surgeon to use a large omentum in non-standard and technically difficult cases. Situations are described in which a radical attitude to the greater omentum is justified – torsion of the omentum strand, metastasis, adhesions, omentitis, entrapment in hernias, complications from the pedicle flap. Analysis of the literature revealed ambiguous results of omentization and omentoplasty, which indicates the need for randomized studies in this area, the development of clinical recommendations for these operations with a description of clear indications and methods of carrying out.
... Most LA hernias consist only of asymptomatic ascending protrusions of limited intraperitoneal structures under the LA [1]. Symptomatic LA hernias have been sporadically reported and must be included in the differential diagnosis of a lower abdominal flank pain or mass [2,3]. Symptoms are related to protrusion or incarceration of a colonic segment, an intestine loop, the great omentum [3], an epiploic appendage or a twisted infarcted parietal peritoneal lipomatous appendage as in our patient. ...
... Symptomatic LA hernias have been sporadically reported and must be included in the differential diagnosis of a lower abdominal flank pain or mass [2,3]. Symptoms are related to protrusion or incarceration of a colonic segment, an intestine loop, the great omentum [3], an epiploic appendage or a twisted infarcted parietal peritoneal lipomatous appendage as in our patient. ...
... Usually the defect has a greater transverse diameter than the anteroposterior one (3, 6). The internal mammary artery and its vein and lymphatics are the only anatomic structures that cross over this space to become the epigastric artery (5)(6). ...
... Accounting for 3% of all surgically repaired diaphragmatic hernias, it is the rarest diaphragmatic hernia (5,10). It occurs far more common on the right side of the diaphragm (90%) despite protection of the liver (3, [5][6]8). ...
... Most patients with MH do not have any symptom and the hernias are usually discovered incidentally (4, 6-8). Symptoms occur mainly in patients who have a hollow viscus included in the herniation (6,(10)(11). Symptoms are nonspecific, frequently digestive or pulmonary such as abdominal discomfort, fullness, bloating, nausea, vomiting, cramps, cough, dyspnea, pain in the chest (4)(5)12). ...
Morgagni hernia is considered to be the rarest form of all diaphragmatic hernias. It develops through a congenital defect in the retrosternal area. Usually asymptomatic, this entity can lead to life-threatening complications such as incarceration, strangulation or volvulus of the herniated viscus. We hereby report a rare case of organoaxial gastric volvulus producing through the foramen of Morgagni in a 78-year-old woman. The full diagnosis was made by upper gastro-intestinal series and multidetector computed tomography (MDCT). The basic anatomy, physiopathology, diagnostic methods, complications and surgical treatment of Morgagni hernia are briefly reviewed.
... The imaging features are presented with a short review of the literature. The case emphasizes the high performances of MDCT for the diagnosis of acute Trocar Site Hernias (3)(4). ...
... Today, thanks to its very high performances in term of spatial resolution, table speed and multiplanar reconstructions (MPR), 64-row MDCT offers unrivalled high quality images of the entire abdominal wall (AW) during a single short breath hold. MDCT thus appears particularly useful for the evaluation of AW hernias, allowing accurate identification of their contents, exquisite analysis of their anatomic landmarks, differentiation from other abdominal masses such hematomas or abscesses and planning of optimal surgical repair (3,4). The reported case confirms the previous reported performances of CT for the evaluation TSH (3,11,(16)(17). ...
... MDCT thus appears particularly useful for the evaluation of AW hernias, allowing accurate identification of their contents, exquisite analysis of their anatomic landmarks, differentiation from other abdominal masses such hematomas or abscesses and planning of optimal surgical repair (3,4). The reported case confirms the previous reported performances of CT for the evaluation TSH (3,11,(16)(17). ...
We report a rare case of early onset type Trocar Site Hernia (TSH) producing in the right lower abdominal quadrant of a 64-year old obese woman. The patient was admitted in the emergency room for abdominal pain producing four days after laparoscopic adnexectomy. The hernia atypically externalized in two-steps creating two superposed concentric small bowel strangulating hernias producing through two distinctive superposed orifices. A precise and complete anatomic diagnosis was made by contrast enhanced 64-row multidetector computed tomography (MDCT). The imaging features are presented with a short review of the literature. The case emphasizes the high performances of MDCT for the early diagnosis of Trocar Site Hernias.
Spiegel's hernias are uncommon anomalies in the Spiegel's aponeurosis, which runs between the rectus muscle and the semilunar line. They are most commonly found in the "Spigel's hernia belt" between the navel and the interspinal line (a horizontal line connecting the anterosuperior iliac spines). We recommend open repair for individuals who arrive with an acute Spiegel's hernia, especially if there is a risk of high-grade blockage, strangulation, intra-abdominal infection, and/or the necessity for bowel resection. Furthermore, open repair may be required due to the surgeon's lack of expertise with and/or experience with laparoscopic methods, or when laparoscopy is contraindicated due to an inability to tolerate pneumoperitoneum or securely access the peritoneal cavity. Sutures or mesh can be used to repair an open Spiegel's hernia. Given the risk of recurrence, we only do suture repair in cases of contamination when mesh implantation is contraindicated and may enhance morbidity.
Résumé
Répondre à toutes les questions légitimes des chirurgiens et des réanimateurs devant un tableau occlusif aigu de l’intestin grêle demeure encore un des principaux défis en matière d’« abdomen urgent » pour le radiologue. Même si, dans la pratique, comme l’a déploré, après bien d’autres, Didier Sicard, « l’examen clinique est souvent devenu le premier examen complémentaire après le scanner ! ». Force est de reconnaître que ce recours très libéral au scanner en urgence dans les tableaux occlusifs aigus a permis, par la coopération des radiologues avec les chirurgiens, des anesthésistes-réanimateurs avec les urgentistes, de définir les éléments sémiologiques scanographiques essentiels sur lesquels on peut établir des bases fiables pour des décisions rationnelles, permettant d’optimiser le moment et la façon de traiter les patients. Il est donc fondamental que la technique d’exploration scanographique, l’exploitation des images avec le recours systématique aux reformations multiplanaires ainsi qu’aux modulations appropriées du contraste et de l’agrandissement soient parfaitement précisées et protocolées. L’analyse précise des items sémiologiques et la bonne compréhension de leur signification physiopathologique, en n’omettant pas les limites statistiques de leur valeur diagnostique sont les piliers du raisonnement diagnostique dont dépend en grande partie la qualité de la prise en charge thérapeutique. Des apports récents de l’imagerie des occlusions intestinales hautes concernent la sémiologie des adhérences intestinomésentériques et la place du test aux hydrosolubles tri-iodés hyperosmolaires dans leur prise en charge thérapeutique.
