SPIGELIAN HERNIA AS A COMPLICATION OF PERITONEAL DIALYSIS
Paul Nguyen1, Jeffrey Wong1, Ananthakrishnapuram Aravindan1 1Department of Nephrology, South Western Sydney Local Health District, Sydney, NSW, Australia
Abstract
Background
Spigelian herniae are uncommon, and account for approximately 2% of ventral herniae. Their development following the initiation of peritoneal dialysis (PD) has been described in the past, with the potential for serious consequences. However in comparison to inguinal, umbilical and exit site herniae, spigelian hernaie have been conspicuously absent from the PD literature in recent times. Here we report a case of a left Spigelian hernia following the commencement of PD.
Case Report
An 83-year-old gentleman with end stage kidney disease, hypertension, chronic obstructive pulmonary disease and previous appendicectomy had a percutaneous Tenckhoff catheter inserted by the Renal intervention service. He was an active smoker, with no history of abdominal herniae and none were detected clinically or ultrasonically during standard pre-procedural assessment. The procedure was performed uneventfully, and he had successful weekly catheter flushes with 500mL of dialysate before proceeding to continuous ambulatory peritoneal dialysis training at 4 weeks post catheter insertion. Initial dialysate fill volumes were tolerated at 1000mL and subsequently increased to 1500mL. A non-tender, reducible swelling on the left anterior abdominal wall inferior to the umbilicus was incidentally noted during catheter dressing change. An ultrasound showed a partially reducible hernia, and a follow-up CT abdomen/pelvis confirmed a Spigelian hernia, with the sac measuring 21x18mm and containing fat and soft tissue. He subsequently also developed a left indirect inguinal hernia and was referred for herniorrhaphy.
Conclusions
Spigelian herniae are an uncommon and almost forgotten complication of PD in comparison to other abdominal herniae. Recognition and referral for prompt surgical intervention is important given the associated high risk of incarceration and strangulation.
Biography
Bio to come