BACKGROUND Spigelian hernia(SH),a protrusion of intra-abdominal contents through a defect in the semilunar line(Spigelian fascia)of the abdominal wall,is extremely rare in the pediatric population.Fewer than 100 cases...BACKGROUND Spigelian hernia(SH),a protrusion of intra-abdominal contents through a defect in the semilunar line(Spigelian fascia)of the abdominal wall,is extremely rare in the pediatric population.Fewer than 100 cases of pediatric SH have been reported in the literature since the first description in 1939.Pediatric SH is often congenital and may present with non-specific symptoms,making diagnosis challenging.Notably,about one-quarter to one-third of reported pediatric cases are associated with ipsilateral undescended testis,an association sometimes termed the"Spigelian-cryptorchidism syndrome".AIM To systematically review all reported cases of Spigelian hernia in children and identify its diagnostic and surgical features.METHODS A comprehensive literature search was performed(1939 through 2023)using PubMed and other databases for all publications on Spigelian(semilunar line)hernias in children.Both English and non-English articles were included.Case reports,case series,and relevant reviews were analyzed.Data extracted included patient demographics,hernia side/location,clinical features,imaging and intraoperative findings,coexisting conditions(particularly cryptorchidism),management(open vs laparoscopic repair),and outcomes.RESULTS A total of approximately 90 pediatric SH cases from 44 publications were identified.The median age at presentation was around 3-4 years(range:Neonate to 17 years).Slight male predominance was observed,although SH also occurs in females.About 30%of cases involved an ipsilateral undescended testis within the hernia sac or in the Spigelian region.Rare associations with other anomalies were noted,including concurrent inguinal hernias,umbilical hernia,and even complex syndromic presentations(for example,limb defects,neuroblastoma)in a few cases.Clinical presentation often included a reducible lump or intermittent bulge along the lateral aspect of the lower abdomen,sometimes misdiagnosed as an inguinal hernia.Recurrent localized abdominal pain was a frequent symptom,and some infants presented with acute intestinal obstruction from incarcerated SH.Diagnosis was most commonly established by ultrasound,which is considered the gold standard imaging modality for SH in children due to its ability to detect fascial defects and herniated tissue dynamically.A subset of cases(approximately 10%)were attributed to blunt abdominal trauma(for example,bicycle handlebar injury),causing an acquired SH.Management:All reported pediatric SHs were treated surgically,given the high risk of incarceration.Open hernia repair through a small transverse incision over the defect was the traditional approach,and no recurrences have been reported after adequate fascial closure.Over the last decade,laparoscopic repair has become the method of choice,especially for cases combined with an undescended testis,allowing simultaneous orchiopexy.Laparoscopic techniques have been successful in safely reducing the hernia and closing the defect,with excellent outcomes and minimal morbidity.CONCLUSION Spigelian hernia in children is a rare but clinically important entity that should be considered in cases of unexplained recurrent abdominal pain,lateral abdominal wall swelling,or cryptorchidism.Early recognition using high-resolution ultrasound and prompt surgical intervention are critical to prevent life-threatening incarceration.Congenital defect of the Spigelian fascia underlies most pediatric cases,and the frequent association with ipsilateral undescended testis suggests a developmental interplay.Surgical repair has excellent outcomes.Increased awareness of pediatric SH among clinicians is necessary to ensure timely diagnosis and treatment,thereby avoiding complications and improving patient outcomes.展开更多
To the Editor:Nowadays,because of the infiltration of cholangiocarcinoma to the parenchyma and/or bile ducts of the caudate lobe,the inclusion of caudate lobe combined with a major hepatectomy remains the gold standar...To the Editor:Nowadays,because of the infiltration of cholangiocarcinoma to the parenchyma and/or bile ducts of the caudate lobe,the inclusion of caudate lobe combined with a major hepatectomy remains the gold standard approach for a resectable hilar cholangiocarcinoma.Since the last years of the 20th century,some authors have begun to report isolated caudate lobe resection for hepatocellular.展开更多
Spigelian Hernia (SH) is an uncommon anterior abdominal wall defect, it represents 0.1%</span><span style="font-family:""> </span><span style="font-family:Verdana;">-&l...Spigelian Hernia (SH) is an uncommon anterior abdominal wall defect, it represents 0.1%</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">2% of all abdominal wall hernias. SHs have been traditionally repaired by open technique, but laparoscopic approaches are becoming more common and widely described in the literature. Here we present a case report of a 69-year-old woman who presented with abdominal pain, nausea, abdominal distention and absence of bowel movements for 2 days. A computed tomography performed in an external facility revealed a right-sided and incarcerated SH containing bowel and mesentery. The patient was treated surgically and the abdominal wall defect was repaired by a laparoscopic transabdominal preperitoneal (TAPP) approach. The patient was discharged 24 hours after surgery in excellent conditions. We hold that the TAPP approach is anatomically the soundest repair, with all the added benefits of minimally invasive surgery.展开更多
中国向非洲派遣医疗队始于1963年,至今已有52年历史。自1975年上海开始向摩洛哥派遣医疗队,至今已有40年历史。疝、胆道疾病是普外科最主要的两大疾病,占择期手术的80%左右。腹壁疝（abdominal wall hernia）因发生部位不同可分为腹部...中国向非洲派遣医疗队始于1963年,至今已有52年历史。自1975年上海开始向摩洛哥派遣医疗队,至今已有40年历史。疝、胆道疾病是普外科最主要的两大疾病,占择期手术的80%左右。腹壁疝（abdominal wall hernia）因发生部位不同可分为腹部疝和腹股沟疝。前者依据部位可分为：白线疝（hernia of linea alba）、半月线疝（spigelian hernia）和脐疝、切口疝等；后者包括：斜疝、直疝、股疝和闭孔疝等。展开更多
文摘BACKGROUND Spigelian hernia(SH),a protrusion of intra-abdominal contents through a defect in the semilunar line(Spigelian fascia)of the abdominal wall,is extremely rare in the pediatric population.Fewer than 100 cases of pediatric SH have been reported in the literature since the first description in 1939.Pediatric SH is often congenital and may present with non-specific symptoms,making diagnosis challenging.Notably,about one-quarter to one-third of reported pediatric cases are associated with ipsilateral undescended testis,an association sometimes termed the"Spigelian-cryptorchidism syndrome".AIM To systematically review all reported cases of Spigelian hernia in children and identify its diagnostic and surgical features.METHODS A comprehensive literature search was performed(1939 through 2023)using PubMed and other databases for all publications on Spigelian(semilunar line)hernias in children.Both English and non-English articles were included.Case reports,case series,and relevant reviews were analyzed.Data extracted included patient demographics,hernia side/location,clinical features,imaging and intraoperative findings,coexisting conditions(particularly cryptorchidism),management(open vs laparoscopic repair),and outcomes.RESULTS A total of approximately 90 pediatric SH cases from 44 publications were identified.The median age at presentation was around 3-4 years(range:Neonate to 17 years).Slight male predominance was observed,although SH also occurs in females.About 30%of cases involved an ipsilateral undescended testis within the hernia sac or in the Spigelian region.Rare associations with other anomalies were noted,including concurrent inguinal hernias,umbilical hernia,and even complex syndromic presentations(for example,limb defects,neuroblastoma)in a few cases.Clinical presentation often included a reducible lump or intermittent bulge along the lateral aspect of the lower abdomen,sometimes misdiagnosed as an inguinal hernia.Recurrent localized abdominal pain was a frequent symptom,and some infants presented with acute intestinal obstruction from incarcerated SH.Diagnosis was most commonly established by ultrasound,which is considered the gold standard imaging modality for SH in children due to its ability to detect fascial defects and herniated tissue dynamically.A subset of cases(approximately 10%)were attributed to blunt abdominal trauma(for example,bicycle handlebar injury),causing an acquired SH.Management:All reported pediatric SHs were treated surgically,given the high risk of incarceration.Open hernia repair through a small transverse incision over the defect was the traditional approach,and no recurrences have been reported after adequate fascial closure.Over the last decade,laparoscopic repair has become the method of choice,especially for cases combined with an undescended testis,allowing simultaneous orchiopexy.Laparoscopic techniques have been successful in safely reducing the hernia and closing the defect,with excellent outcomes and minimal morbidity.CONCLUSION Spigelian hernia in children is a rare but clinically important entity that should be considered in cases of unexplained recurrent abdominal pain,lateral abdominal wall swelling,or cryptorchidism.Early recognition using high-resolution ultrasound and prompt surgical intervention are critical to prevent life-threatening incarceration.Congenital defect of the Spigelian fascia underlies most pediatric cases,and the frequent association with ipsilateral undescended testis suggests a developmental interplay.Surgical repair has excellent outcomes.Increased awareness of pediatric SH among clinicians is necessary to ensure timely diagnosis and treatment,thereby avoiding complications and improving patient outcomes.
文摘To the Editor:Nowadays,because of the infiltration of cholangiocarcinoma to the parenchyma and/or bile ducts of the caudate lobe,the inclusion of caudate lobe combined with a major hepatectomy remains the gold standard approach for a resectable hilar cholangiocarcinoma.Since the last years of the 20th century,some authors have begun to report isolated caudate lobe resection for hepatocellular.
文摘Spigelian Hernia (SH) is an uncommon anterior abdominal wall defect, it represents 0.1%</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">2% of all abdominal wall hernias. SHs have been traditionally repaired by open technique, but laparoscopic approaches are becoming more common and widely described in the literature. Here we present a case report of a 69-year-old woman who presented with abdominal pain, nausea, abdominal distention and absence of bowel movements for 2 days. A computed tomography performed in an external facility revealed a right-sided and incarcerated SH containing bowel and mesentery. The patient was treated surgically and the abdominal wall defect was repaired by a laparoscopic transabdominal preperitoneal (TAPP) approach. The patient was discharged 24 hours after surgery in excellent conditions. We hold that the TAPP approach is anatomically the soundest repair, with all the added benefits of minimally invasive surgery.
文摘中国向非洲派遣医疗队始于1963年,至今已有52年历史。自1975年上海开始向摩洛哥派遣医疗队,至今已有40年历史。疝、胆道疾病是普外科最主要的两大疾病,占择期手术的80%左右。腹壁疝（abdominal wall hernia）因发生部位不同可分为腹部疝和腹股沟疝。前者依据部位可分为：白线疝（hernia of linea alba）、半月线疝（spigelian hernia）和脐疝、切口疝等；后者包括：斜疝、直疝、股疝和闭孔疝等。
