Successful management of recurrent coccygeal hernia with the de-epithelialised rectus abdominis musculocutaneous flap

Mesh repair of sacrococcygeal hernia via a combined laparoscopic and sacrococcygeal approach: A case report

BACKGROUND

Sacrococcygeal hernia is a very rare condition that is usually secondary to sacrococcygectomy, and its ideal treatment regimen is unclear. Herein, we report a case of sacrococcygeal hernia occurring in a patient who had no history of sacrococcygeal operation, present the operative procedures of mesh repair via a combined laparoscopic and sacrococcygeal approach that has not been described, and discuss our experience in diagnosis and treatment with a review of the literature.

CASE SUMMARY

A 54-year-old woman who chiefly complained of a 10-year history of a reversible bulge in her right sacrococcygeal region was admitted to our hospital. The physical examination revealed a bulge in the right sacrococcygeal region upon standing, which disappeared in the prone position but relapsed when performing the Valsalva manoeuvre. Computed tomography displayed an abnormality in the structure of the tissues between the midline of the sacrococcygeal region and the right gluteus muscle. The patient was diagnosed with sacrococcygeal hernia and received hernia repair with mesh through a combined laparoscopic and sacrococcygeal approach. On laparoscopy, the rectum was dissected posterolaterally, and a defect was identified in the right anterior sacrococcygeal region through which part of the rectum protruded. This was followed by the placement of a self-gripping polyester mesh via a sacrococcygeal approach. There were no postoperative complications. The patient was discharged on postoperative day 7 and was followed for more than 6 mo with no recurrence.

CONCLUSION

Laparoscopic mesh repair is recommended as a priority of surgical options for sacrococcygeal hernias, while choosing a self-gripping mesh can help avoid the risk of presacral vessel injury by reducing suture fixation.

Repair of a coccygeal hernia with a biological mesh

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We present a case of coccygeal hernation after coccygectomy.

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Hernia repair was performed with a biological mesh via an direct approach.

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Only 8 other cases could be identified in literature.

Coccygeal herniation after coccygectomy is rare. Little is known about the management of this complication. We present a case of a 44 year old women with a coccygeal herniation 7 years after coccygectomy. She was treated two times for an infected pilonidal sinus with incision and drainage. After the last incision and drainage she had complaints of a painful swelling in the sacral area and difficulty with evacuation of her stools. A defaecography showed a coccygeal herniation. An additional MRI of the pelvic region showed a defect with a diameter of approximately 38 mm. We performed a hernia repair with a biological mesh (Strattice™ surgical mesh, LifeCell Corporation USA) via a sacral approach. Her recovery was complicated by a small wound dehiscence without clinical signs of infection. The sacral wound healed per secundam. Her complaints had completely disappeared. A defaecography 2 months after surgery showed no residual herniation. To our knowledge, it is the first reported case of a coccygeal hernia repair with a biological Strattice™ surgical mesh.

Incidental detection of bowel herniation with ultrasonography and fluoroscopy during a caudal block

BACKGROUND

In contrast to fluoroscopy, ultrasonography allows visualization of structures such as muscles, tendons, vessels, and nerves. We describe a case where ultrasonography in conjunction with fluoroscopy led to the incidental diagnosis of bowel herniation in a patient undergoing a caudal block.

CLINICAL FEATURES

A 71-yr-old woman presented to our chronic pain clinic with a long-standing history of coccydynia for which she had undergone a partial coccygectomy. A trial caudal block was planned. Fluoroscopy of the lower sacral area revealed the presence of a gas bubble inferoposteriorly to the coccygeal remnant. A confirmatory ultrasound scan revealed a hollow structure compatible with bowel. The procedure was abandoned. Subsequently, a non-enhanced computed tomographic scan of the pelvis confirmed the diagnosis of large bowel herniation. The patient was referred to a colorectal surgeon, and she subsequently underwent successful laparoscopic repair of the coccygeal hernia.

CONCLUSION

Ultrasonography can be a valuable adjunct in identifying non-neural pathologies in patients undergoing interventional procedures in chronic pain management. This case report highlights the importance of being vigilant for unanticipated pathologies during ultrasound examinations while performing chronic pain block procedures.