Giant Spiegelian hernia and abdominal trauma: cause or coincidence?

BACKGROUND: Spiegelian hernia is an uncommon entity and occurs as a result of a defect in the linea semilunaris located in the lateroventral abdominal wall. CLINICAL CASE: We report the case of a 44-year-old female with a history of progressive abdominal swelling. Clinical history included a previous blunt trauma to the abdomen. A Spiegelian hernia with a large aponeurotic defect (7 × 12 cm) and sac (15 × 15 cm) was diagnosed. A literature review of similar topics was performed. CONCLUSION: Weakness presented in the linea semilunaris in Spiegelian hernia may be caused either spontaneously or as a consequence of factors that increase intra-abdominal pressure. Otherwise, it is important to unify the terms related to the size of this entity in order to establish a correct classification.

Evaluation of previous abdominal pain episodes in women with biliary pancreatitis: possible higher incidence of recurrent attacks.

BACKGROUND AND AIM: Recurrent biliary pancreatitis is described as episodes of new abdominal pain after diagnosis of pancreatitis. Few studies have analyzed the abdominal pain before the diagnosis of acute pancreatitis. Our study aimed to analyze factors associated with previous abdominal pain episodes in patients with biliary pancreatitis, and elucidate its possible pancreatic origin. METHODS: Data from direct interrogation and medical records was analyzed from 48 hospitalized female patients with diagnosis of acute biliary pancreatitis. RESULTS: Mean age of our patients was 31.6 years (SD +/- 13.9). Forty one (85.4%) patients gave history of at least one previous abdominal pain episode. During the episode 37 (90.2%) patients received H2 receptor antagonist or proton pump inhibitors as treatment; 26 (63.4%) had epigastric pain; 23(56.1%) gave association with cholecystokinetic food; 21 (51.2%) complained of nausea and/or vomiting; 23 (56.1%) had jaundice, acholia and/or dark urine; and 20 (48.9%) patients had microlithiasis and/or biliary sludge. CONCLUSIONS: Previous abdominal pain episodes had similar characteristics to a pancreatic episode in a high percentage of our patients. These characteristics suggest that these episodes are often undiagnosed pancreatic attacks.