LAUSR

An abdominal pseudohernia is a protrusion of the abdominal wall that resembles a hernia, but differs from a true hernia in that there is no real muscle disruption and all muscle layers remain intact. Pseudohernias are rare conditions that are caused by atrophy of the abdominal musculature. They have been described in association with neuropathy sultrasoundndary to medical causes or post-lumbotomy. Pseudohernias resulting from medical causes are resolved partially or totally, while those sultrasoundndary to a surgical complication do not improve. To date, they have not been described after spinal cord injury. The objective of this paper is to reported the cases of 3 patients who developed abdominal pseudohernias after spinal cord injury. These patients were identified in the outpatient clinic of the spinal cord injury unit from 2009 to 2015. At a follow-up visit, each had reported diffuse symptoms, including unilateral abdominal heaviness, lumbar discomfort or imbalance while sitting, but no clear limitations for activities of daily living. Two of these patients had been referred by their family doctor to the general surgery department with the diagnosis of abdominal hernia. The patients began reporting symptoms 4–6 months after the spinal cord injury. The 3 patients were males between the ages of 45 and 57. In 2 cases, the spinal cord injury was caused by a trauma injury (D12-L1 fractures), and in the third case the origin of the spinal cord injury was medullary ischemia affecting the lumbosacral spinal cord segments and produced an incomplete medullary lesion. Clinical examination revealed abdominal asymmetry (Fig. 1). The cranial magnetic resonance imaging (MRI) study of the vertebral-medullary trauma causing the spinal cord injury was reviewed, and an abdominal ultrasound, electromyogram of the abdominal wall and measurement of the abdominal wall thickness by ultrasound were requested, as well as a new spinal MRI if there had been surgery after the spinal cord injury (Table 1). In the 3 cases, there was unilateral involvement of the L1 root, which caused unilateral thinning of the abdominal wall. The patients, who have continued in follow-up in the outpatient clinic of the ULM, have continued to present the same clinical symptoms and examination results for 2–8 years. Described by Taylor in 1895, abdominal pseudohernia has usually been described in various studies as a medical complication of a herpes zoster infection or diabetic radiculopathy. Likewise, it has also been described after surgery, invasive diagnostic procedures or rib fractures. Unlike the cases described in the literature where the neurological lesion occurred in the peripheral nerve, the cases presented in this study relate the origin of the pseudohernia with a unilateral lesion of the anterior horn of the spinal cord. c i r e s p . 2 0 1 8 ; 9 6 ( 9 ) : 5 8 7 – 5 9 7