Interparietal Postoperative Hernia. Presentation of Two Cases

Abstract Aim Interparietal postoperative hernias are rare cases where the content herniates through layers of the abdominal wall, without reaching the skin and the subcutaneous fat. They are difficult to diagnose, since they cannot be palpated from the outside. They usually present acutely with small bowel obstruction. Case 1 69-year-old female with a history of gastrectomy 8 years before, Rives-Stoppa for incisional hernia 4 years before and multiple episodes of partial small bowel obstruction. CT scan showed small bowel loops between the posterior rectus sheath and the mesh. Surgery confirmed the diagnosis of interparietal hernia, the small bowel was reduced and the posterior sheath was sutured. The previous mesh was not removed and a new mesh was placed underneath it. Case 2 38-year-old female with a history of caesarean section 1 year before, presented to the emergency room with acute lower abdominal pain. No mass was palpated. CT scan showed incisional hernia with small bowel loops between the rectus muscle and the anterior sheath. Intraoperatively, the small bowel was reduced and the abdominal wall was sutured by layers. Conclusion Interparietal hernia is rare, with only case reports in the literature. It will usually present as an emergency and the CT scan is invaluable for the diagnosis. The difference in our cases, compared to others published, is that in our cases the interparietal hernia presented itself, long after the index operation.