Resumo
Traunatic perineal hernia remains a rare clinical entity despite an overall increase in blunt trauma. Because of the incidence of other associated injuries, the mortality is high. Most of the perineal defects are repaired during the orthopaedics surgery to reconstitute the pelvis and few patients develop a true perineal hernia without pelvic instability. A 80-year-old woman was involved in a running over accident with disjunction of pubic symphysis, dislocation of sacrum-iliac junction and fracture of pubis and ischium. The patient was submitted to an orthopaedic surgery and latter development an perineal hernia through the genitalia. The diagnosis could be established with physical examination alone. Conventional radiology, computadorized tomography, and ultrasound should also be done to progran the surgery. The repair approach was performed using a marlex mesh, fixed in the pelvic bones, Cooper ligament, and the abdominal wall. The mesh was stood in a retro- peritoneal position, rebuilding the pelvic floor without reconstruction the pelvic bones. We conclude that this is an efficient approach to repair of traumatic postoperative perineal hernia, mainly in patients with high operative risk, when the osseous repair is not necessary.
Perineal hernia; Traumatic abdominal hernia; Marlex mesh
Perineal hernia; Traumatic abdominal hernia; Marlex mesh
RELATOS DE CASOS
Hérnia perineal após disjunçao da sínfise púbica: apresentação de caso e técnica para correção
Perineal hernia after dislocation of pubic symphysis: case report and repair technique
Alberto Julius Alves Wainstein, ACBC-MGI; João Marcos Arantes Soares, RCBC-MGII; Bruno de Freitas BeleziaIII; Manoel Jacy Vilela LimaIV
ICirurgião Geral Membro do Serviço de Gastroenterologia. Nutrição e Cirurgia do Aparelho Digestivo do Hospital das Clínicas da UFMG. Cirurgião Geral da Fundação Hospitalar do Estado de Minas Gerais. Pós-Graduando da Faculdade de Medicina da UFMG
IICirurgião Geral. Mestre em Medicina
IIICirurgião Geral
IVProfessor Assistente do Departamento de Cirurgia da UFMG. Coordenador do Grupo de Parede Abdominal e Retroperitônio do Serviço de Gastroenterologia, Nutrição e Cirurgia do Aparelho Digestivo do Hospital das Clínicas da UFMG
Endereço para correspondência Endereço para correspondência: Dr. Alberto Julius A. Wainstein Rua Curitiba. 2.550/1902 30170-122 - Belo Horizonte - MG
ABSTRACT
Traunatic perineal hernia remains a rare clinical entity despite an overall increase in blunt trauma. Because of the incidence of other associated injuries, the mortality is high. Most of the perineal defects are repaired during the orthopaedics surgery to reconstitute the pelvis and few patients develop a true perineal hernia without pelvic instability. A 80-year-old woman was involved in a running over accident with disjunction of pubic symphysis, dislocation of sacrum-iliac junction and fracture of pubis and ischium. The patient was submitted to an orthopaedic surgery and latter development an perineal hernia through the genitalia. The diagnosis could be established with physical examination alone. Conventional radiology, computadorized tomography, and ultrasound should also be done to progran the surgery. The repair approach was performed using a marlex mesh, fixed in the pelvic bones, Cooper ligament, and the abdominal wall. The mesh was stood in a retro- peritoneal position, rebuilding the pelvic floor without reconstruction the pelvic bones. We conclude that this is an efficient approach to repair of traumatic postoperative perineal hernia, mainly in patients with high operative risk, when the osseous repair is not necessary.
Key words: Perineal hernia; Traumatic abdominal hernia; Marlex mesh.
Texto completo disponível apenas em PDF.
Full text available only in PDF format.
Recebido para publicação em 2/1/97
Aceito para publicação em 25/8/97
Trabalho realizado no Serviço de Gastroenterologia, Nutrição e Cirurgia do Aparelho Digestivo do Hospital das Clínicas da Universidade Federal de Minas Gerais - UFMG.
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- 2. Cali RL, Pitsch RM, Blatchford GJ., et al.- Rare pelvic floor hernias: Report of a case and review of the literature. Dis Colon Rectum 1992; (6):604-612.
- 3. Wood RJ. Ney AL, Bubrick MP. Traumatic abdominal hernia: A case report and review of the literature. Am Surg 1988;4: 648-651.
- 4. Leuchter RS. Lagasse LD, Hacker NF, et al. Management of post- exenteration perineal hernias by myocutaneous axial flaps. Gynecol Oncol 1982;4(1):15-22.
- 5. Stoppa R, Petit J, Abourachid H. Proced original de plastie des herniese de lains: L'interposicion sans fixation d'une prothese en tulle de Dacron por voie mediane sous-peritoneale. Chirurgie 1973;99: 119-223.
Endereço para correspondência:
Datas de Publicação
-
Publicação nesta coleção
26 Jul 2010 -
Data do Fascículo
Fev 1998
Histórico
-
Aceito
25 Ago 1997 -
Recebido
02 Jan 1997
