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Background: This study aimed to investigate the diagnosis and treatment of thoracic anterior spinal cord herniation, a rare condition., Methods: Clinical data of 7 patients diagnosed with thoracic anterior spinal cord herniation were analyzed. All patients were diagnosed with a complete preoperative examination and scheduled for surgical treatment. In addition, regular follow-up was performed after the surgery, and the operation's efficacy was evaluated according to clinical symptoms, imaging findings, and improvement in neurologic function., Results: All patients underwent spinal cord release with an anterior dural patch. Notably, no severe postoperative surgical complications were observed. All patients were followed up for 12-75 months, with an average duration of approximately 46.5 months. Post-operative pain symptoms were controlled, neurological dysfunction and related symptoms improved to varying degrees, and anterior spinal cord herniation did not recur. The modified Japanese Orthopedic Association score at the last follow-up was significantly higher than the preoperative score., Conclusions: Clinicians should avoid misdiagnosing patients with thoracic anterior spinal cord herniation with intervertebral disc herniation, arachnoid cysts, and other related diseases, and patients should undergo surgical treatment as early as possible. In addition, surgical treatment can protect the neurologic function of patients and effectively prevent the aggravation of clinical symptoms., (Copyright © 2023. Published by Elsevier Inc.)

Thoracic hernias are defined as the protrusion of contents either into or outside of the thoracic cavity. These hernias can be acquired or congenital and occur in varying locations. Acquired thoracic hernias typically develop after surgery or trauma. The most common form is intercostal herniation due to thoracotomy. Trans-mediastinal herniation of the lung is even less common, typically seen in patients with sequestration, scimitar syndrome, or pneumonectomy, and, when present, commonly occurs across the anterior mediastinum. Here, we present to our knowledge the first known case of posterior trans-mediastinal lung herniation diagnosed on CT after thoracoabdominal aneurysm repair in a patient with Marfan's disease, highlighting the importance of evaluating for rare anatomic complications in the post-operative setting. (1) ., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Idiopathic spinal cord herniation (ISCH) is a rare pathology characterized by extravasation of the spinal cord through a dural defect. The optimal algorithm for choosing operative or nonoperative management is not well elucidated, partially because of the rarity of this pathology. We present the largest single-center series of ISCH and compare operative treatment to conservative management., Methods: A retrospective case series of all patients evaluated for treatment of ISCH at our institution between 2010 and 2019 was conducted. Demographic variables, presenting symptoms, and imaging characteristics were assessed for all patients. For patients who underwent operative treatment, surgical approach, postoperative course, and discharge outcomes were recorded. Follow-up notes were reviewed for status of symptoms and functional capabilities, which were synthesized into Odom's criteria score., Results: Sixteen patients met the inclusion criteria for this study, 8 of whom underwent operative treatment. No significant differences were found between operative and nonoperative groups with regard to demographic variables or pathology characteristics. Odom's criteria scores for the operative cohort were 12.5% (1 of 8) Excellent, 62.5% (5 of 8) Good, 12.5% (1 of 8) Fair, and 12.5% (1 of 8) Poor. Odom's criteria scores for the nonoperative cohort were 16.7% (1 of 6) Excellent, 33.3% (2 of 6) Good, 16.7% (1 of 6) Fair, and 33.3% (2 of 6) Poor. There was no significant difference between Odom's criteria score distribution between the operative and nonoperative groups at latest follow up (P = 0.715)., Conclusions: Conservative management of spinal cord herniation is an option that does not preclude symptomatic improvement in patients with idiopathic spinal cord herniation., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The sinking skin flap syndrome, also known as the syndrome of the trephined or the trephination syndrome, occurs in patients who have undergone a decompressive craniectomy. As opposed to this, persistent brain herniation also occurs in patients after a decompressive craniectomy and a cerebrospinal fluid (CSF) drainage procedure is one of the therapies used to reduce it. A continuous lumbar CSF drainage procedure can upset the pressure dynamics of the atmosphere versus intracranial pressures to a point of fatal clinical deterioration and hence needs to be closely monitored., Case Description: Our case report speaks of persistent brain herniation in which drainage of CSF led to a trephination syndrome, which was reversed once again, by measures to increase CSF production and intracranial pressure., Conclusions: Timely intervention eventually led to a favorable outcome and avoidance of a catastrophy., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Slit-ventricle syndrome (SVS) is a recognized complication of ventricular shunt malfunction, resulting in cyclical symptoms without ventricular dilatation. We present a case of SVS with transient, repetitive, and progressive signs of brainstem herniation evidenced by pupillary dilatation, posturing, and unresponsiveness, with diffuse voltage attenuation on electroencephalogram (EEG)., Case Description: A 32-year-old female presented with a history of hydrocephalus and ventriculoperitoneal shunt placement at 9 months of age. She began experiencing significant headaches in college, later accompanied by stereotypical 5- to 25-minute episodes of unresponsiveness, posturing and pupillary dilatation, and failing anticonvulsant therapy. No neurosurgical evaluation was sought because of small ventricles on brain imaging. Episodes became progressively more frequent over a 10-year period, eventually occurring daily. On presentation, 5 clinical events were captured on EEG over 12 hours of monitoring. With each episode, she became unresponsive and hypertensive, with fixed, dilated pupils and flexor posturing. Between events, she was awake and alert, without confusion or postictal state. She had papilledema and limited extraocular movements, with normal pupils and vital signs. Computed tomography scanning showed small ventricles. A shunt tap revealed no flow. With each episode onset, an EEG revealed an abrupt background rhythm slowing to 2-3 Hz delta range without epileptiform discharges. Between events, EEGs displayed normal waveform activity. Emergent ventriculoperitoneal shunt revision resulted in no further episodes in a 4-year follow-up period., Conclusions: SVS can lead to severe intermittent brainstem herniation syndrome in the setting of shunt malfunction. Seizure diagnosis should be reserved for cases with proven functional shunt and EEG confirmation of epileptiform activity., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Imaging is increasingly being used in urogynaecology. Because of low cost and universal availability, ultrasound (US) is the most commonly used diagnostic modality, which allows the observation of manoeuvres such as Valsalva and pelvic floor muscle contraction in real time. The ability to see beyond surface anatomy is particularly important in the posterior compartment and in obstructed defecation where this method may replace defecation proctography. Imaging is especially useful in the form of 3D/4D multiplanar and tomographic translabial US, as these modalities give access to the axial plane and the levator ani. This allows assessment of both avulsion, i.e. major maternal birth trauma, and hiatal overdistension, i.e. ballooning. Both are major risk factors for both prolapse and prolapse recurrence. This review will outline current clinical utility, introduce recent research in the respective field and provide an overview of likely future utility of imaging in the investigation of pelvic organ prolapse., (Copyright © 2018. Published by Elsevier Ltd.)

We evaluated the relationship between infraorbital fat herniation and age-related changes in the bony orbit and orbital fat density using computed tomography. Two hundred and sixty-five patients were enrolled (60 patients were evaluated for changes in the bony orbit and 205 for changes in orbital fat density). Five measurements using parasagittal sections and one measurement using three-dimensional images were obtained. Intraorbital fat herniation length was positively correlated with orbital rim inclination. Lowering of the inferior orbital rim, which is connected to the orbicularis retaining ligament, tear trough ligament and orbital septum, can cause mechanical stretching of the lower eyelid and may contribute to infraorbital fat herniation. A strong and significant negative correlation was observed between orbital fat density and age, indicating that existing orbital fat can accommodate an enlargement in bony orbit volume without orbital fat hyperplasia/hypertrophy. In other words, an increased orbital fat volume may be a by-product of the adaptation of orbital fat to changes in bony orbit volume. Mechanical stretching of the lower eyelid due to ageing of the bony orbit and weakening of the lower eyelid due to age-related factors such as dermal/fat/muscle atrophy and loss of muscle tone can together result in anterior drooping of the lower eyelid. Therefore, age-related changes in the bony orbit contribute to intraorbital fat herniation., (Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Recognition of transdural spinal cord herniation has increased over the past decade. This condition remains little known, particularly outside the specialized fields of spinal surgery and neuroradiology, leading to a significant delay in clinical diagnosis and treatment. It should be considered among the differential diagnoses in patients with gradual-onset lower-limb weakness of presumed spinal origin. Reaching a diagnosis using magnetic resonance imaging is essential to refer patients for surgery before their myelopathy worsens. We describe our surgical experience to untether the spinal cord by wrapping a dura graft around the spinal cord. Three case reports and a review of the literature are discussed., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Complete uterine rupture is a rare and severe intrapartum complication with high rates of maternal and fetal mortality. Asymptomatic uterine rupture is a very rare condition with one unique previous case described in the literature. Three-dimensional virtual models allow an immersive virtual reality of maternal-fetal structures with better understanding by the parents and the medical team., Case: We demonstrate a case of asymptomatic rupture uterine with a large amniocele and protruded legs and umbilical cord at 28 weeks of gestation by using a 3-D virtual model from ultrasound scan data., Conclusion: 3-D virtual models may be applied to the assessment of obstetric complications, thereby allowing a novel 3-D spatial view of maternal-fetal structures., (Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

The duodenum is a short segment of the bowel that is frequently overlooked on radiologic examination. This unique portion occupies both intraperitoneal and extraperitoneal locations, with proximity to many visceral organs, including pancreas, stomach, aorta, and liver. This close proximity creates a differentiation challenge for the radiologist. Duodenal pathologies are categorized into neoplastic and nonneoplastic conditions. Majority of radiologists are familiar with duodenal neoplasm. However, duodenal involvement by a multitude of nonneoplastic conditions can be encountered. The majority of related radiology studies have concentrated on neoplasms of the duodenum-either primary or secondary. However, a broad range of nonneoplastic conditions merit discussion. In this review, multimodality imaging features of nonneoplastic duodenal diseases are discussed and emphasized., Objective: To conduct a systematic review of the frequent imaging features of nonneoplastic diseases of the duodenum, with an emphasis on accurate diagnosis so that the patient who will benefit from treatment can be identified., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Report of a case of surgically confirmed closed-loop small bowel obstruction due to internal hernia following transperitoneal ureter reimplantation. Multidetector computed tomography (CT) demonstrated the presence and the cause of this unusual postsurgical internal hernia. The CT findings are presented herein., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Small bowel obstruction is a common condition encountered by the radiologist in the emergency department. Though intestinal adhesions and obstructed hernias are the most common causes of acute small bowel obstruction, a variety of uncommon and rare conditions can cause acute and subacute bowel obstruction. Imaging plays a key role in the workup of bowel obstruction by identifying the cause, level, and degree of bowel obstruction. In this article, we present a comprehensive review of the multi-detector computed tomography features of common and uncommon causes of acute and subacute small bowel obstruction., (Copyright © 2014 Elsevier Inc. All rights reserved.)

We herein describe a case with an internal hernia that developed after laparoscopic abdominoperineal resection for rectal cancer. The small intestine passed through the space between the sigmoid colon loop of the stoma and the abdominal wall. Internal hernias associated with colostomy are rare; however, the condition is an important complication, because it causes ischemia in both the herniated intestine and the sigmoid colon pulled through the abdominal wall as a stoma., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Richter's hernia is associated with rapid onset of gangrene and a high mortality. We report a case of a strangulated inguinal Richter's hernia of the cecum requiring a laparotomy and bowel resection. Due to the misleading clinical presentation, a high index of suspicion, particularly in patients with a history of laparoscopic surgery, will minimize delay in diagnosis., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Congenital absence of the pericardium is a rare entity, with less than 400 cases reported in the literature. Pericardial absence is typically left sided, which results in herniation of the great vessels or portions of the heart. Patients may be asymptomatic, typical for complete defects, or can present with various degrees of chest pain in the setting of partial absence and strangulation. The finding may be isolated or associated with complex heart disease. We present a number of cases of pericardial absence that show isolated right- and left-sided defects, as well as entities in the differential diagnosis. Early recognition may decrease morbidity and mortality, resulting from delay in proper treatment., (Published by Elsevier Inc.)

Lung herniation after first rib resection for thoracic outlet syndrome (TOS) has not been reported to our knowledge. We present a unique case of cervical lung herniation causing displacement of the brachial plexus and chronic pain in a patient who had previously undergone supraclavicular thoracic outlet decompression with first rib resection. This was successfully treated with thoracoscopic reduction and resection of the herniated lung and pleural flap closure of the defect., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

A 64-year-old man with a history of esophageal adenocarcinoma status postneoadjuvant therapy underwent esophagogastrectomy. Postoperatively he was found with increasing dyspnea and oxygen requirements. Computed tomography of the chest showed retrocardiac herniation of atelectatic lung into the contralateral hemithorax., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Paraduodenal hernia is a rare congenital malformation. Although it may be an incidental finding at autopsy or at laparotomy, some cases are symptomatic. In such a condition, imaging is mandatory for the diagnosis. In the clinical literature, only a few cases of paraduodenal hernia diagnosed with computed tomography (CT) have been reported. We report two cases of surgically proven right paraduodenal hernia diagnosed preoperatively by multislice helical CT., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Pulmonary agenesis is a rare congenital disease that is associated with many other congenital anomalies. We present the case of a patient, with right pulmonary agenesis and transmediastinal lung herniation, who presented with a spontaneous pneumothorax. This congenital anomaly and the treatment for this rare presentation is discussed in detail., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

If undiagnosed, traumatic pericardial rupture with herniation of the heart may have fatal consequences. We report two cases of multiple trauma with pericardial rupture, which was missed in the preoperative diagnoses of both patients, in spite of suggestive signs on computed tomographic scans. One patient had unexplained, persistent hemodynamic instability; the second patient had cardiac arrest during laparotomy for minor hepatic laceration. In both, the left-sided rupture of the pericardium with cardiac herniation into the pleural space was found and corrected in an emergency intervention. Both patients recovered completely., (2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Traumatic pneumatocele is a rare complication of blunt chest trauma with uncertain pathogenesis. It occurs primarily in pediatric patients and is characterized by single or multiple pulmonary cystic lesions concomitant with other type of injuries of the lung parenchyma. Herein we present a case of traumatic pneumatocele in a 3-year-old boy, together with a brief review of the literature. This rare entity should be considered in the differential diagnosis of cystic lesions complicating blunt chest trauma, especially in young adults. The disease generally has a benign and self-limiting course., (Copyright 2010 Taiwan Pediatric Association. Published by Elsevier B.V. All rights reserved.)

Uncal herniation due to a large cerebral infarct is well-described in adults, with high rates of morbidity and mortality. This phenomenon, however, has not been previously reported in neonates. We present a newborn male delivered via cesarean section with difficult extraction who presented with frequent seizures. He was found to have an acute left MCA territory infarct secondary to an M1 occlusion detected on MRI/MRA. He became lethargic and developed a left uncal herniation on CT at 72h of life. He was treated medically with osmolar agents and hemodynamic support, and had resolution of the herniation on CT at 120h of life. At 19 months he had residual moderate right hemiparesis with only mild gait disturbance and mild speech delay. As seen in this case, uncal herniation, though rare, may occur in neonates. Also, the outcome for this neonate was much better than for typical adults with a similar disease course.

Because guidelines for the treatment of blowout fractures have not been defined for urgent-care surgery, some patients retain a sight-threatening strabismus after surgery. The authors present a case involving the immediate operation of a blowout fracture based on CT findings and symptoms, demonstrating that early intervention may restore the full range of motion in the affected eye. The CT image showing the absence of the inferior rectus muscle on the orbital floor and no apparent fracture indicates the muscle strangulation. Immediate surgery must be performed to prevent irreversible muscular degeneration in such cases, rather than delaying the procedure by several days.

We describe a novel technique for dealing with the rare complication of post-traumatic or post-thoracotomy lung herniation. The method uses techniques and fixation devices that have been developed for stabilization and fixation of the spine and surgical management of scoliosis. It allows for a secure, reliable, and easily reproducible fixation of the chest-wall in patients with large intercostal lung hernias using standard spinal instruments.

A 43-year-old man was admitted to the emergency department after a cardiac arrest of unknown etiology. The patient's medical history was unremarkable except for surgery to remove a mediastinal lipoma two years earlier. In the intensive care unit, he was observed to have a mass bulging from the left chest wall. Echocardiography showed cardiac herniation through the chest wall, which was confirmed by thoracic computed tomographic scan.

The congenital intrapericardial hernia is a rare kind of diaphragmatic hernia. It is due to an embryologic defect of the central tendon of the diaphragm, often accompanied by other congenital malformations. This work presents a unique case report in the literature of the congenital association between intrapericardial diaphragmatic hernia and epigastric hernia in an adult woman. In spite of herniation of the colon and omentum the patient was completely asymptomatic, requesting surgery for an epigastric hernia for aesthetic reasons. The defect of the diaphragm was sutured and the abdominal wall was repaired with a prosthetic mesh.

Background: When the neck is flexed in patients with Chiari I malformation, herniated tonsils descend, impacting the spinal canal, and the clivus-canal angle changes and compresses the ventral spinal cord. Therefore, we speculated that the existence of tonsillar herniation might have some influence on the cervical spine, such as changes in range of motion, sagittal alignment, and spondylosis. The purpose of this radiological study was to clarify quantitatively the relation between tonsillar herniation and the cervical spine regarding range of motion, sagittal alignment, and cervical spondylotic change., Methods: We examined the cervical spine of 609 outpatients with magnetic resonance imaging, and the cerebral tonsils being located below the foramen magnum was defined as tonsillar herniation. Of the 609 patients, 88 (14.4%) had tonsillar herniation. Two of the 88 patients who had complicating osseous anomalies were excluded from this study, and the remaining 86 patients with tonsillar herniation were the subject group (TH group). Of the remaining 521 patients without tonsillar herniation, 86 patients whose age and sex matched those of the TH group were selected at random to be in the control group (Non-TH group). The range of motion, sagittal alignment, and the diameter of the intersegmental dura in the cervical spine in the TH group were compared by age with those in the Non-TH group using a roentgenograph or magnetic resonance imaging., Results: The range of motion at C1-C2 was significantly smaller in the TH group (5.4 degrees ) than in the Non-TH group (8.4 degrees ) in patients over 70 years of age. The level of narrowing of the dura diameter at C5/C6 was significantly higher (P = 0.029) in the TH group (23.3%) than in the Non-TH group (13.4%) in patients over 70 years of age. The cervical alignment was similar in both groups for all age groups., Conclusions: The existence of tonsillar herniation was associated with loss of range of motion at the upper cervical spine and progression of spondylotic change, especially in elderly patients.

Herniation through the gastroepiploic foramen into the lesser sac is a rare cause of intestinal obstruction. The nonspecific nature of its presentation makes early diagnosis of this condition difficult. Internal herniation should be considered with a high index of suspicion in intestinal obstruction due to the high rate of morbidity and mortality associated with delayed treatment. We report the first case of caecal herniation with strangulation in the gastroepiploic foramen occurring in a postoperative patient. Decompression and reduction of the strangulated caecum was performed, followed by a right hemicolectomy. The clinical and radiological features are presented from a review of the literature on gastroepiploic foramen herniation.

Objective: Two methods for area and volume calculation of the orbit were evaluated following blow-out fractures of the orbital floor using computed tomography (CT) scans., Material and Methods: Isolated blow-out fractures of the orbital floor in human cadavers were simulated by fracturing the orbital floor and placing a defined volume of silicone within each defect. The area of fracture and the volume of silicone simulating herniated periorbital tissue were evaluated in 16 orbits by the use of a three-dimensional (3D) CT-based software package (Analyze((R)); Mayo Clinic, Rochester, MN, USA) and software based on two-dimensional (2D) coronal CT scans. Both methods were compared with direct anatomical measurements and evaluated with Lin's concordance coefficient (rho(c))., Results: Between-method concordance of area and volume calculation were rho(c)=0.962, and 0.872 for the 3D-CT-based method, and 0.981 and 0.952 for the 2D-CT method, respectively. The time allocated for measurement was significantly longer for the 3D-CT than for the 2D-CT method (p<0.001)., Conclusion: Calculations of blow-out fractures of the orbital floor by 3D-CT and 2D-CT method are accurate for assessing the area of fracture and the volume of herniated tissue. Lesser processing time and simple usage favour the 2D-CT-based calculation method., (Copyright 2002 European Association for Cranio-Maxillofacial Surgery. Published by Elsevier Science Ltd.)

We report a case of lung herniation occurring following video-assisted thoracic surgery. Although lung hernias are rare, the widespread application of video-assisted thoracic surgery to patients at risk for lung hernia will likely result in more reports in the future. Consequently, pulmonologists and thoracic surgeons must be aware of this condition, risk factors for development, and potential methods of prevention in order to minimize the occurrence of this complication.

Objectives: We describe a series of patients with rectal prolapse who had other pelvic floor defects., Study Design: Patients with rectal prolapse that we examined between 1990 and 2000 were reviewed., Results: During this time frame 55 patients with rectal prolapse were seen by one of us. Fifty-two of these patients had other defects of pelvic floor support and are the subject of this report. The diagnosis was established in all patients with video defecography. Thirty-nine of the patients had internal (occult) prolapse that simulated either a rectocele or an enterocele. The mean number of surgical procedures for pelvic floor support before the diagnosis of rectal prolapse was 1.5. Thirty-one patients underwent a sigmoid resection with rectopexy, 12 underwent a rectopexy alone, 3 underwent a Ripstein procedure, 2 elderly patients had physical therapy alone, and the other 4 patients had surgical correction of the rectal prolapse before being referred for repair of vaginal vault prolapse. Other procedures performed simultaneously included sacral colpopexy, sacrospinous suspension, rectopubic urethropexy, and abdominal fixation of the vagina to the uterosacral ligaments., Conclusions: Rectal prolapse frequently coexists with other pelvic floor defects. Internal rectal prolapse may simulate a rectocele or enterocele and requires defecography to establish the diagnosis. Rectopexy (with or without sigmoid resection) is a satisfactory technique for correction and may be combined with other reconstructive procedures on the pelvic floor.