Fatal outcome of a lumbar incisional hernia originating at the surgical site of hip arthroplasty: An exceptionally rare
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CASE REPORT
Fatal Outcome of a Lumbar Incisional Hernia Originating at the Surgical Site of Hip Arthroplasty: An Exceptionally Rare Case Marcelo A. Beltrán
Abstract This article discusses an uncommon case of complicated incisional lumbar hernia secondary to total hip arthroplasty. A female patient with a history of bilateral total hip arthroplasty at another institution was hospitalized for acute oedematous pancreatitis and was treated conservatively. An initial abdominal computerized tomography showed the incidental finding of a left lumbar hernia in close relationship with a hip prosthesis. During the 30th day of hospital stay, the incisional hernia became incarcerated, and the intestinal contents strangulated. The severity of this complication finally led to the death of the patient. Despite their rarity, these hernias should be included within the differential diagnosis of flank masses and late hip arthroplasty symptomatic complications. Key words: Incisional hernia, lumbar hernia, hip arthroplasty
Introduction Hip arthroplasty is associated with multiple complications, among which soft tissues hernias have been reported, such as the vastus lateralis muscle herniated through a fascia lata defect [1]. Other authors have reported the herniation of abdominal viscera through the wing of the ileum following bone-grafting procedures [2,3]. However, the protrusion of abdominal contents through an incisional hernia as a consequence of total hip arthroplasty has only been described on one occasion in the English surgical literature [4]. The present article describes a rare case of incisional hernia secondary to total hip arthroplasty, complicated with incarceration and strangulation that led to a fatal outcome.
Clinical case A 72-year-old female obese patient was admitted to our institution with the diagnosis of acute oedematous biliary pancreatitis. She had significant associated diseases such as diabetes, hypothyroidism, and chronic cardiac failure secondary to advanced Chagas’s disease. She also had a cardiac pacemaker and coronary stents. Five years earlier,
Marcelo A. Beltrán, M.D. Department of Surgery, Hospital de La Serena, Department of Clinics, Facultad de Medicina, Universidad Católica del Norte Corresponding author: Marcelo A. Beltrán, M.D. P.O. Box 912, Calle Manuel Antonio Caro 2629, La Serena – IV Región – Chile e-mail: [email protected] Received 12 June 2014; Accepted 26 July 2014
Hellenic Journal of Surgery 86
she had undergone a bilateral total hip replacement secondary to osteoarthritis at another institution. Two days after admission, she was submitted to abdominal computed tomography (CT) to stratify the pancreatitis. An unexpected finding in this case was that of a non-complicated left flank large incisional hernia (Figure 1). The hernia was located immediately over the iliac crest and was intimately related to a total hip arthroplasty replacement prosthesis. It was noted that the right hip prosthesis was fixated with three screws while the left prosthesis was fixated with six screws, thr
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