Postherpetic abdominal-wall pseudohernia

Abstract

Conflict of interest: none declared. A 76‐year‐old man was referred to us with a painless protrusion of the left abdominal wall, which became more prominent on standing, coughing and straining. Approximately 2 weeks before presentation, he had developed a painful herpetic rash on the skin. Physical examination revealed grouped, cloudy, filled vesicles and blisters on an erythematous base in the affected dermatomes and a compressible, painless swelling of the left flank, 150 × 100 mm in size. There was an area of reduced muscle tone but no palpable defect in the abdominal wall (Fig. 1). Neurological examination found the superficial abdominal reflexes to be diminished on the left side and hypoaesthesia of the overlying skin was present. Needle electromyography of paravertebral thoracic muscles revealed denervation changes limited to the muscles on the left side, corresponding to affected dermatomes from T10 to L1 levels. On abdominal ultrasonography, peristaltic contractions of transverse colon were seen in the area of the bulge. Thoracoabdominal computed tomography showed diastases of the muscles of the left abdominal wall, which was thinner than the right side, and no presence of real hernia or mass.