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Peripartum Perineal Hernia: A Case Report and a Review of the Literature

Hines, Katherine N., MD; Badlani, Gopal H., MD; Matthews, Catherine A., MD

Female Pelvic Medicine & Reconstructive Surgery: September/October 2018 - Volume 24 - Issue 5 - p e38–e41
doi: 10.1097/SPV.0000000000000534
Review Article

Objectives This article reviews the literature for the management and repair of perineal hernias and presents a previously undescribed case of perineal bladder herniation after intrapartum pubic symphysis rupture.

Methods A review of the literature was completed through the PubMed database using the search terms “bladder,” “canal of Nuck,” “labial hernia,” “gynecology,” “hernia,” “obstetrics,” “perineal hernia,” “postpartum,” “pubic diastasis,” “pubic symphysis,” “vaginal delivery,” “symphyseal rupture,” and “symphyseal separation.” The electronic medical record for the patient was reviewed and used with the consent of the patient.

Results There were no reports of peripartum perineal hernias in the English language literature on human subjects. Literature review with the previously mentioned search terms demonstrated that there is not a standardized approach to repair given the rarity of these defects. There are data to support the use of mesh as opposed to primary repair but no data to support abdominal versus perineal versus combined approach. We describe a successful repair of a complicated peripartum perineal hernia using a combined abdominal-perineal approach with mesh.

Conclusions Obstetric trauma is a previously unreported cause of perineal hernias. Perineal hernias are rare conditions that must be considered in any patient who presents with a bulging perineal mass. Puerperal pubic symphysis rupture can lead to a large bladder hernia. Our combined abdominal-perineal approach of repair resulted in minimal perioperative morbidity and short-term resolution of the hernia.

From the Department of Urology, Wake Forest Baptist Health Medical Center, Winston Salem, NC.

Correspondence: Katherine N. Hines, MD, Department of Obstetrics and Gynecology, Wake Forest Baptist Health Medical Center, 1 Medical Center Blvd, Winston Salem, NC 27157. E-mail: knhines@wakehealth.edu.

Author contributions: Manuscript writing and editing: K.N.H. and C.A.M. Manuscript editing: G.H.B.

C.A.M. has grant support from Boston Scientific and Pelvalon and is a consultant to Pelvalon. G.H.B. is a consultant to Olympus America and Neotract. K.N.H. has no disclosures.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.