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.

This is a preview of subscription content, access via your institution.

Fig. 1a–b
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. 1.

    Mohta A, Bhargava SK (2004) Congenital perineal hernia: report of a case. Surg Today 34:630–631

    PubMed  Article  Google Scholar 

  2. 2.

    Thomford NR, Sherman NJ (1969) Primary perineal hernia. Dis Colon Rectum 12:441–443

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Salum MR, Prado-Kobata MH, Saad SS, Matos D (2005) Primary perinea posterior hernia: an abdominoperineal approach for mesh repair of the pelvic floor. Clinics 60:71–74

    PubMed  Article  Google Scholar 

  4. 4.

    Preiss A, Herbig B, Dorner A (2006) Primary perineal hernia: a case report and review of the literature. Hernia 10:430–433

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Merchav R, Feuermann Y, Shamay A, Ranen E, Stein U, Johnston DE, Shahar R (2005) Expression of relaxin receptor LRG7, canine relaxin, and relaxin-like factor in the pelvic diaphragm musculature of dogs with and without perineal hernia. Vet Surg 34:476–481

    PubMed  Article  Google Scholar 

  6. 6.

    Niebauer GW, Shibly S, Seltenhammer M, Pirker A, Brandt S (2005) Relaxin of prostatic origin might be linked to perineal hernia formation in dogs. Ann N Y Acad Sci 1041:415–422

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Bell JG, Weiser EB, Metz P, Hoskins WJ (1980) Gracilis muscle repair of perineal hernia following pelvic exenteration. Obstet Gynecol 56:377–380

    PubMed  CAS  Google Scholar 

  8. 8.

    Barnhill D, Hoskins W, Heller P, Repka M, Park R (1985) Repair of vaginal prolapse and perineal hernia after pelvic exenteration. Obstet Gynecol 65:764–766

    PubMed  CAS  Google Scholar 

  9. 9.

    Santora TA, Kaplan LJ, Sherk HH (1998) Perineal hernia: an undescribed complication following sacrectomy. Orthopedics 21:203–205

    PubMed  CAS  Google Scholar 

  10. 10.

    So JB, Palmer MT, Shellito PC (1997) Postoperative perineal hernia. Dis Colon Rectum 40:954–957

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    de Campos FG, Habr-Gama A, Araujo SE, Sousa AH Jr, Nahas CR, Lupinacci RM, Nahas SC, Kiss DR, Gama-Rodrigues J (2005) Incidence and management of perineal hernia after laparoscopic proctectomy. Surg Laparosc Endosc Percutan Tech 15:366–370

    PubMed  Article  Google Scholar 

  12. 12.

    Ghellai AM, Islam S, Stoker ME (2002) Laparoscopic repair of postoperative perineal hernia. Surg Laparosc Endosc Percutan Tech 12:119–121

    PubMed  Article  Google Scholar 

  13. 13.

    Franklin ME Jr, Abrego D, Parra E (2002) Laparoscopic repair of postoperative perineal hernia. Hernia 6:42–44

    PubMed  Article  Google Scholar 

  14. 14.

    Delmore JE, Turner DA, Gershenson DM, Horbelt DV (1987) Perineal hernia repair using human dura. Obstet Gynecol 70:507–508

    PubMed  CAS  Google Scholar 

  15. 15.

    Bell JG, Weiser EB, Metz P, Hoskins WJ (1980) Gracilis muscle repair of perineal hernia following pelvic exenteration. Obstet Gynecol 56:377–380

    PubMed  CAS  Google Scholar 

  16. 16.

    Remzi FH, Oncel M, Wu JS (2005) Meshless repair of perineal hernia after abdominoperineal resection: case report. Tech Coloproctol 9:142–144

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Bongartz A, Carofiglio F, Balligand M, Heimann M, Hamaide A (2005) Use of autogenous fascia lata graft for perineal herniorrhaphy in dogs. Vet Surg 34:405–413

    PubMed  Article  Google Scholar 

  18. 18.

    Vnuk D, Babic T, Stejskal M, Capak D, Harapin I, Pirkic B (2005) Application of a semitendinosus muscle flap in the treatment of perineal hernia in a cat. Vet Rec 156:182–184

    PubMed  CAS  Google Scholar 

  19. 19.

    Berrevoet F, Pattyn P (2005) Use of bone anchors in perineal hernia repair: a practical note. Langenbecks Arch Surg 390:255–258

    PubMed  Article  Google Scholar 

  20. 20.

    Hansen MT, Bell JL, Chun JT (1997) Perineal hernia repair using gracilis myocutaneous flap. South Med J 90:75–77

    PubMed  CAS  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to D. N. Anderson.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Skipworth, R.J.E., Smith, G.H.M. & Anderson, D.N. Secondary perineal hernia following open abdominoperineal excision of the rectum: report of a case and review of the literature. Hernia 11, 541–545 (2007). https://doi.org/10.1007/s10029-007-0234-3

Download citation

Keywords

  • Perineal hernia
  • Mesh
  • Pelvic floor
  • Abdominoperineal excision of rectum
  • Radiotherapy
  • Chemotherapy