Unilateral lower abdominal wall protrusion and umbilical deviation

Key Clinical Message

Postherpetic pseudohernia must be suspected when a patient develops motor dysfunction coincident with or following a herpes zoster eruption.

A 75‐year‐old woman presented with right lower abdominal pain and a rash. Two weeks later, although the pain was resolving, she noticed a right lower abdominal wall protrusion associated with skin discomfort. Deviation of the umbilicus and central line of the abdomen to the left was also observed (Fig. 1). The abdominal wall protrusion became more prominent with Valsalva's maneuver. The patient had hyperpigmentation of the right T11‐12 dermatomes (Fig. 2), and revealed reduced muscle tone in the same area. Her past medical history included uterine myoma treated with myomectomy. Abdominal computed tomography did not reveal a hernia or mass. Three months after symptom onset, the patient fully recovered without intervention.

Figure 1.

Deviation of the umbilicus and central line of the abdomen to the left.

Figure 2.

Hyperpigmentation of the right T11‐12 dermatome.

What is the clinical diagnosis?

Discussion

Postherpetic abdominal pseudohernia is uncommon, occurring in 2% of patients with herpes zoster 1. It must be suspected when a patient develops motor dysfunction coincident with or following a herpes zoster eruption. Deviation of the umbilicus and central line of the abdomen to the unaffected side, similar to the facial finding in Bell's palsy, suggests abdominal wall muscle paralysis. Recognizing this symptom is important, since postherpetic abdominal pseudohernia is potentially reversible and does not require surgical intervention.

Conflict of Interest

None declared.

Clinical Case Reports 2016; 4(4): 451–452