Pseudo Hernia: A Case Report of Post Therapeutic Post Herpes Zoster Motor Neuron Disease
Introduction: Pseudo hernia is defined as bulging of the abdominal wall that is not caused by structural defects rather, frequently due to muscle paralysis. Pseudo-hernia/Phantom-hernia due to herpes zoster is also known as abdominal wall postherpetic pseudo- hernia, herpes zoster-induced abdominal paresis and segmental roster abdominal paresis. Approximately 5% of patients with herpes zoster experience motor complications such as facial palsy, ramsay hunt syndrome, ogilvie’s syndrome or segmental paresis of the limbs. Pseudo hernia due to herpes zoster is also a rare motor complication of herpes zoster and occurs in approximately 0.17% of cases. Elderly and immuno compromised patients are at higher risk of developing motor deficits due to herpes zoster. Motor deficits usually occur in the same or adjacent levels as to where the virus is infected. Generally, abdominal bulging due to herpes zoster is asymptomatic, but when the visceral nerve is involved in the gastrointestinal tracts, colonic pseudo-obstruction and constipation-associated symptoms can concur.
Case report: A 60-year-old male presented to surgery OPD of Jawaharlal Nehru Medical College, Aligarh Muslim University for expansile left-sided flank swelling and discomfort for 2 months. He was admitted with a clinical impression of a left lumbar hernia. Abdominal ultrasonography didn't reveal any abdominal wall defect. Detailed history revealed severe burning pain and vesicles along the left T9-10 dermatome 3 months back. A diagnosis of herpes zoster was made and the patient was given famciclovir for a week. Following which skin lesions improved, though chronic left-sided flank discomfort and mild burning pain remained and bulge appeared after 1 month of treatment. A final diagnosis of Pseudo hernia, the complication of herpes zoster was then made and the patient was kept under close observation. He was tolerating a normal diet. His pain had subsided and was discharged in satisfactory condition. He has been on regular follow up since then.
Conclusion: Pseudo hernia due to herpes zoster usually shows a good prognosis, with self-regression after a few months. In most reported cases, symptoms resolve without treatment between 3 and 12 months after onset. Surgeons should be very aware of both contamination and such unusual presentations.