SALMAN A SIDDIQUI amp WENDY S COALTER ALTNAGELVIN HOSPITAL WHSCT LONDONDERRY NORTHERN IRELAND AFFILIATED WITH QUEENS UNIVERSITY BELFAST INTERESTING CASE salmansiddiquiwesterntrusthscninet ID: 934070
Download Presentation The PPT/PDF document "TRANSLEVATOR PERINEAL HERNIA MIMICKING A..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
TRANSLEVATOR PERINEAL HERNIA MIMICKING A SINISTER RECTAL MASS
SALMAN A SIDDIQUI &
WENDY S COALTERALTNAGELVIN HOSPITAL, WHSCT, LONDONDERRY, NORTHERN IRELANDAFFILIATED WITH QUEEN’S UNIVERSITY BELFAST
INTERESTING CASE
salman.siddiqui@westerntrust.hscni.net
wcoalter01@qub.ac.uk
AUTHORS’ EMAILS:
Slide2CASE REPORT
INTRODUCTION:
Translevator perineal hernia is a rare entity which can be primary (congenital) or more commonly secondary (acquired), predominantly seen in middle aged females 1,2. We present a rare case of an elderly lady with an incidental finding of posterior perineal hernia mimicking a sinister rectal mass on CT imaging.DISCUSSION:The limited available literature describes CT findings and its utility in establishing the diagnosis of perineal hernias 3-5. This case highlights the limitation of CT when findings are not definitive and the role of MRI as a superior problem solving tool to better delineate the pelvic anatomy, confirm the diagnosis and exclude differential diagnoses.
CASE HISTORY:An elderly 84 year old lady presented with worsening frailty and weight loss (approximately one stone over 12 months) but no altered bowel habits or tenesmus. Her medical background includes Parkinson’s disease and hysterectomy for non-cancerous cause. Clinical examination was grossly unremarkable. Blood tests were also normal. She underwent CT chest, abdomen and pelvis which revealed eccentrically thickened rectal wall with an
exophytic component extending into the left ischiorectal fossa. No other abnormality was identified.
MRI rectum was performed prior to flexible sigmoidoscopy which revealed a small Richter's type hernia of the left lateral rectal wall through a defect in the left levator ani muscle. No suspicious rectal thickening or mass was identified. Previous hysterectomy was presumed to be an etiology of the perineal hernia. Surgical repair was considered not appropriate for this incidental asymptomatic perineal hernia in an elderly frail lady.
REFERENCES:
Cicero G, Blandino A, Pergolizzi S, Caudo
D, Bottari A, Mazziotti S. Posterior
perineal
hernia long after surgery: Our experience. Journal of Medical Imaging and Radiation Oncology. 2019;63(3):356-357.
Mistry
V,
Halder
A,
Saad
N. Primary posterior
perineal
hernia:
IncidentalCTdiagnosis
of a rare pelvic floor hernia. Journal of Medical Imaging and Radiation Oncology. 2018;63(2):222-224.
Hubbard AM,
Egelhoff
JC. Posterior
perineal
hernia presenting in infancy as a
gluteal
mass.
Pediatr
Radiol
1989; 19:246.
Poon
FW, Lauder JC, Finlay IG.
Perineal
herniation
.
Clin
Radiol
1993; 47:49-51.
Lubat
E, Gordon RB,
Birnbaum
BA,
Megibow
AJ. CT diagnosis of posterior
perineal
hernia, AJR 1990; 154:761-2
Slide3Axial T2W (C) & coronal T2W (D) MRI sequences through the pelvis clarifying the CT findings as a small Richter's
type hernia of the left lateral rectal
wall (red arrows) through a 22 mm defect in the left levator ani muscle (yellow arrowheads), in keeping with left posterolateral translevator perineal hernia. Axial (A) & coronal (B) CT images through the pelvis demonstrating eccentrically thickened left posterolateral rectal wall (white arrowheads) with an exophytic
component (yellow arrows) breeching the meso
-rectal fascia and extending into the left ischiorectal fossa
at 4 o‘clock position, raising the concern for a sinister locally advanced rectal mass.
(A)
(C)
(B)
(D)