title: Secondary perineal hernia following open abdominoperineal excision of the rectum: report of a case and review of the literature.
abstract: This is a case report of a 46-year-old man who presented with a painful perineal lump four months after abdominoperineal excision of the rectum (APER) with pre-operative radiotherapy and adjuvant chemotherapy. Perineal hernia (suspected clinically) was confirmed by magnetic resonance imaging, and the patient underwent open Permacol mesh repair via a perineal approach. Symptomatic perineal herniation after surgical resection is a rare phenomenon, and the approach to management remains challenging. Several different surgical approaches and techniques of repair have been described. In this report, we review the literature surrounding the presentation, aetiology and repair of this unusual post-operative complication. Furthermore, our case confirms that closure of the hernial orifice with mesh via a perineal approach is a satisfactory technique.
authors.affiliation: Department of Surgery, NHS Lothian, University Hospitals Division, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK. rskipworth@hotmail.com
authors.forename: R J E
authors.initials: RJ
authors.lastname: Skipworth
authors.forename: G H M
authors.initials: GH
authors.lastname: Smith
authors.forename: D N
authors.initials: DN
authors.lastname: Anderson
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery*; D001706:Biopsy; D005500:Follow-Up Studies; D006547:Hernia / Q000175:diagnosis / Q000209:etiology*; D059685:Herniorrhaphy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010502:Perineum; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000295:instrumentation; D019651:Plastic Surgery Procedures / Q000379:methods*; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D013526:Surgical Mesh; D014057:Tomography, X-Ray Computed