title: An atypical lateral hernia and concomitant inguinal and umbilical hernias in a patient with polycystic kidney disease and an intracranial aneurysm - a combined approach of clinical and radiological investigation, endoscopic hernia repair, and anatomical cadaver model documentation and a systematic review of the literature.
abstract: Atypical hernias are difficult to diagnose due to their rarity and often unspecific symptoms. In the literature there exist hints to peri-inguinal hernias, i.e. direct lateral hernia, but most of them are forms of Spigelian hernias. Since the majority were described during the first half of the past century or even earlier, only very few cases have been documented using modern diagnostic techniques. We report a unique case of a 51 year old patient presenting with an atypical inguinal hernia with concomitant inguinal and umbilical hernias in combination with cystic kidney disease and intracranial aneurysm. The atypical position of the hernia was assumed from clinical inspection, ultrasound and CT scan and verified during pre-peritoneoscopy. Using an anatomical cadaver dissection approach, we followed the unusual position of the hernia through the abdominal wall below the aponeurosis of the external oblique muscle. After a thorough literature search, we assume that the present hernia containing a hernial sac has not been documented before, especially not in such a multidisciplinary approach comprising radiological, surgical and anatomical localisation and endoscopic treatment in a patient with a clinical situation being aggravated by large cystic kidneys leading to dialysis-dependency. Rare hernias have been described as being often associated with concomitant inguinal or other hernias, a predisposition for the male gender and a pathogenic mechanism related to other soft tissue defects such as cystic kidney disease or cranial aneurysm. Thus, we consider this a unique case that has not been documented in this constellation previously, which may increase the awareness for these rare hernias.
authors.affiliation: Department of Surgery, Waid Hospital, Tièchestrasse 99, Zürich, CH-8037 Switzerland.
authors.forename: László
authors.initials: L
authors.lastname: Veréb-Amolini
authors.affiliation: Department of Radiology, Waid Hospital, Tièchestrasse 99, Zürich, CH-8037 Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Betschart
authors.affiliation: Department of Radiology, Waid Hospital, Tièchestrasse 99, Zürich, CH-8037 Switzerland.
authors.forename: Emilia
authors.initials: E
authors.lastname: Kiss
authors.affiliation: Institute of Anatomy, University of Zürich, Winterthurerstrasse 190, Zürich, CH-8057 Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Ullrich
authors.affiliation: Department of Surgery, Waid Hospital, Tièchestrasse 99, Zürich, CH-8037 Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wildi
authors.affiliation: Institute of Anatomy, University of Zürich, Winterthurerstrasse 190, Zürich, CH-8057 Switzerland ; Institute of Neuroradiology, University Hospital, Otto-von-Guericke-University, Leipziger Strasse 44, Magdeburg, D-39120 Germany ; Current address: Department of Anatomy II, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, D-91054 Germany.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Eppler
keywords: ADPKD; Endoscopic hernia repair; Interparietal hernia; Intracranial aneurysm; Kidney transplant; Lateral ventral hernia; Para-inguinal hernia; Polycystic kidney disease; Spigelian hernia