Hernias

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Case Report

DOI:
10.4103/0189-6725.99411

Perineal hernias in children: Case report and
review of the literature

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Dragan Kravarusic, Michael Swartz1, Enrique Freud

ABSTRACT
Perineal hernias (pelvic floor hernias) are extremely
rare occurring through defects in musculature of thepelvic floor. This report presents a successfully treated
case of primary perineal hernia and takes a review of
the existing literature. The case of a 14-month-old girl
with a great perineal hernia is presented. Diagnosis
was secured by barium enema. The pelvic defect was
successfully treated by primary suture with prolene.
T he literature shows many different approaches
for treatment ofperineal hernia, such as open or
laparoscopic mesh repair, and perineal, abdominal or
combined access in the adult, but our case like others
confirms that primary closure of the hernial orifice
through a perineal approach is also feasible in children.
Key words: Children, pelvic floor, perineal hernia,
suture repair

INTRODUCTION
Hernias of the pelvic floor are extremely rare, [1,2]
and theyinclude in order of decreasing frequency:
obturator, perineal and sciatic hernias.[3,4] Among the
perineal hernias, an anterior and a posterior form can
be delineated [Figure 1] based on their position relative
to the transverse perineii muscle. The orifice of the
anterior form is located in the urogenital diaphragm.
Clinical manifestation is a prolapse in the area of the
labia. The orificeof the posterior form is located either
in the levator ani muscle itself or between levator ani
muscle and coccygeus muscle.

with this condition, a correct preoperative diagnosis
is obligatory as erroneous approach in surgery carries
unnecessary risk with dire consequences.
In this report, we present our experience in the
diagnosis and treatment of perineal hernia with a review
ofrelevant literature, first at the Schneider Children’s
Medical Center.

CASE REPORT
The patient was a female infant born at 36 gestational
weeks after a normal pregnancy and delivery. Birth
weight was 2600 g. Shortly after delivery, her father
noticed a swelling on her left buttock. The swelling
had a bluish discoloration and was initially believed
to be a hematoma of unknown origin. Because ofsome breathing difficulties, the infant was admitted
to the Neonatal Intensive Care Unit for observation.
T he next day, this problem resolved without any
specific treatment. On routine examination, the slight
bluish swelling of the left buttock was still present.
Except of mild constipation, the child was completely
asymptomatic. Hernia was first suspected at the first
follow-up visit,when her mother reported that the
mass increased in size when the child cried. Clinical

Since the treatment of perineal hernia is surgical, and
because of the diagnostic dilemma often associated
Department of Surgery, Schneider Children’s Medical Center of Israel,
Petah Tikva, 1Department of Radiology, Sackler Faculty of Medicine,
Tel Aviv University, Tel Aviv, Israel
Address forcorrespondence:
Dr. Dragan Kravarusic, Department of Pediatric and Adolescent Surgery,
Schneider Children’s Medical Center of Israel, Petah Tiqwa - 49202, Israel.
E-mail: Dragank@clalit.org.il

172

May-August 2012 / Vol 9 / Issue 2

1 = Anterior perineal hernia, 2 = Posterior perineal hernia
A = Penile shaft, B = Penile medial raphe, C = Bulbospongiousus muscle, D = Ischiocavernosus muscle, E =Perineal membrane, F = Perineal body, G = Superficial
transverse perineal muscle, H = Superficial external anal
sphincter muscle, I and K = Levator ani muscle [I =
Pubococcygeous, K = Ischiococcygeous muscle], L =
Gluteus maximus muscle, deep external anal sphincter
muscle

Figure 1: Anatomy of the male pelvic floor

African Journal of Paediatric Surgery

Kravarusic, et al.: Perineal...
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