R G Holzheimer1. 1. Praxisklinik Sauerlach, Germany. Gresser.holzheimer@web.de
Abstract
UNLABELLED: Traumatic abdominal wall hernias have significant implications for patients and insurance companies, especially when not been discovered at the time of trauma. We present the case of a gardener who sustained a bad fall during work in 1994 with immediate admission to the hospital for treatment. A fracture of the second lumbar spine body has been diagnosed and stabilized operatively. Postoperative computer tomography and magnetic resonance examinations demonstrated correct healing of the fracture. Neither the pain in the sacral spine, the left leg and left lower abdominal wall nor the sudden pain attacks in the groins with preference of the left groin stopped. Different neurologists considered as cause of the unchanged pain in the lower abdomen and left leg a radiculopathy in the lumbar spine. As a result of the neurological assessment the patient was operated in the lumbar spine (fixation of the fourth and fifth body) in a different hospital in 2007, unfortunately without elimination of the pain and no change of the neurological defects. The complaints increased to an extent that the patient was unable to drive a car, climb stairs or walk a longer distance. In 2008, when he was examined by the rheumatologist and internal medicine specialist, Prof. Dr. Ursula Gresser, in the Praxisklinik Sauerlach, the diagnosis of a traumatic abdominal wall hernia and isolated nerve compression syndrome was made. Prof. Gresser referred the patient to my hernia centre for surgical treatment. The intraoperative findings and histological examination of tissue were consistent with this diagnosis. The difficult meticulous repair of the 14 years old massive defects of the several layers of the abdominal wall and compression of nerves, when crossing these layers, has been made possible in a time demanding open approach with special care for the viable tissue and anatomy. Immediately after the operation the patient had no longer pain in the sacral spine, with a massive decline of pain level in the remaining areas. Without any further pain medication the patient is now able to climb stairs, walk longer distances and drive his car. CONCLUSION: Patients suffering from pain and neurological alterations in the lower abdomen, groins and legs, with or without known trauma, may have a traumatic abdominal wall hernia and nerve compression syndrome. Before planning extensive orthopaedic operations in spine and hip, it is rewarding to exclude other causes, e.g., Sportsman hernia, traumatic hernia or occult hernia. A treatment of the hernia is absolutely necessary to avoid loss of quality of life for the patient and further detrimental development to the patient, e.g., destruction of the head of the femur, deterioration of the respiratory activity and lordosis of the spine. One should not get distracted by evident fractures in the spine to look for other causes of pain.
UNLABELLED: Traumatic abdominal wall hernias have significant implications for patients and insurance companies, especially when not been discovered at the time of trauma. We present the case of a gardener who sustained a bad fall during work in 1994 with immediate admission to the hospital for treatment. A fracture of the second lumbar spine body has been diagnosed and stabilized operatively. Postoperative computer tomography and magnetic resonance examinations demonstrated correct healing of the fracture. Neither the pain in the sacral spine, the left leg and left lower abdominal wall nor the sudden pain attacks in the groins with preference of the left groin stopped. Different neurologists considered as cause of the unchanged pain in the lower abdomen and left leg a radiculopathy in the lumbar spine. As a result of the neurological assessment the patient was operated in the lumbar spine (fixation of the fourth and fifth body) in a different hospital in 2007, unfortunately without elimination of the pain and no change of the neurological defects. The complaints increased to an extent that the patient was unable to drive a car, climb stairs or walk a longer distance. In 2008, when he was examined by the rheumatologist and internal medicine specialist, Prof. Dr. Ursula Gresser, in the Praxisklinik Sauerlach, the diagnosis of a traumatic abdominal wall hernia and isolated nerve compression syndrome was made. Prof. Gresser referred the patient to my hernia centre for surgical treatment. The intraoperative findings and histological examination of tissue were consistent with this diagnosis. The difficult meticulous repair of the 14 years old massive defects of the several layers of the abdominal wall and compression of nerves, when crossing these layers, has been made possible in a time demanding open approach with special care for the viable tissue and anatomy. Immediately after the operation the patient had no longer pain in the sacral spine, with a massive decline of pain level in the remaining areas. Without any further pain medication the patient is now able to climb stairs, walk longer distances and drive his car. CONCLUSION:Patients suffering from pain and neurological alterations in the lower abdomen, groins and legs, with or without known trauma, may have a traumatic abdominal wall hernia and nerve compression syndrome. Before planning extensive orthopaedic operations in spine and hip, it is rewarding to exclude other causes, e.g., Sportsman hernia, traumatic hernia or occult hernia. A treatment of the hernia is absolutely necessary to avoid loss of quality of life for the patient and further detrimental development to the patient, e.g., destruction of the head of the femur, deterioration of the respiratory activity and lordosis of the spine. One should not get distracted by evident fractures in the spine to look for other causes of pain.