ISSN: 2378-3397

Montero-Puga et al. Int J Surg Res Pract 2023, 10:157

DOI: 10.23937/2378-3397/1410157
Volume 10 | Issue 2
International Journal of Open Access

Surgery Research and Practice

Case Report

Clinical Expressions of Herniosis: Report of a Case

Jesús Andrés Montero-Puga1*, Guillermo Padrón-Arredondo2 and Adriana Teresa Cruz-Méndez2
General Surgery Resident, Cínica-Hospital Mérida APP del ISSSTE, Mexico
1

General Surgeons, Cínica-Hospital Mérida APP del ISSSTE, Mexico

2 Check for
updates

*Corresponding author: Jesús Andrés Montero-Puga, General Surgery Resident, Facultad de Medicina-UADY, Cínica-
Hospital Mérida APP del ISSSTE, Street 21 s/n Comisaría de Susulá, Mérida Yucatán, PC: 97314, México, Tel: +52-9991046660

Summary Introduction
Introduction: The etiology of hernias involves changes in The etiology of hernias involves changes in the
the expression of different components of the extracellular expression of different components of the extracellular
matrix, which especially affect the fascia transversalis matrix, which especially affect the fascia transversalis
(FT), such as collagen, the elastic component and
metalloproteinases (MMP). On the other hand, there is an (FT), such as collagen, the elastic component and
overexpression of MMP-2 in the FT of young patients with metalloproteinases (MMP). On the other hand, there is
direct inguinal hernia, correlated with an increase in TGF- an overexpression of MMP-2 in the FT of young patients
beta1 that shows an attempt to counteract an increased with direct inguinal hernia, correlated with an increase
process of degradation of the extracellular matrix in these
in TGF-beta1 that shows an attempt to counteract an
patients.
increased process of degradation of the extracellular
Clinical case: A 63-year-old female with a family history matrix in these patients. At the level of the elastic
of maternal grandmother with bilateral and umbilical
inguinal hernia, father with retinal detachment and inguinal tissue of the FT, patients with hernia show lower levels
hernia, pathological personal history of essential arterial of tropoelastin (TE), monomers that make up elastin,
hypertension, dyslipidemia, and multiple hemangiomas and lysyloxidase like-1 (LOXL-1), an enzyme involved
distributed throughout the body. She comes to consult in elastin crosslinking. All this is accompanied by a
due to increased volume in the right inguinal region for 3
years, in the left inguinal region for two years, both without
significantly higher expression of elastase, the main
treatment, which increased with the Valsalva maneuver enzyme involved in the process of elastin degradation.
and currently one in the umbilical region, denying nausea, In cell cultures from FT, the levels of mRNA encoding
vomiting, fever, pain or constipation. Physical examination, LOXL-1 were also found to be significantly lower in
skin color unchanged, reducible, not incarcerated, not patients with direct inguinal hernia.
strangled. The diagnostic protocol was started where the
presence of bilateral inguinal and umbilical hernia was All these alterations highlight a disorder at the level
evidenced, for which a surgical programming was decided of the extracellular matrix of the connective tissue in
to perform abdominal wall plasty. Right and left inguinal
plasty with mesh and umbilical plasty without mesh were patients with inguinal hernias, which together with
performed. other exogenous factors (smoking, mechanical stress,
Discussion: In the last 30 years, research on the
tissue aging, etc.) would partly explain the genesis of
etiopathogenesis of abdominal wall hernias has revealed this pathology [1,2].
that one of the causes is due to multifactorial systemic
tissue disease, currently known as herniosis. Clinical Case
Keywords A 63-year-old female with a family history of
maternal grandmother with bilateral and umbilical
Hernia, Abdominal wall, Metalloproteins, Collagen, Elastin
inguinal hernia, father with retinal detachment and
inguinal hernia, pathological personal history of
essential arterial hypertension, dyslipidemia, and
Citation: Montero-Puga JA, Padrón-Arredondo G, Méndez AT (2023) Clinical Expressions of Herniosis:
Report of a Case. Int J Surg Res Pract 10:157. doi.org/10.23937/2378-3397/1410157
Accepted: November 23, 2023; Published: November 25, 2023
Copyright: © 2023 Montero-Puga JA, et al. This is an open-access article distributed under the terms
of the Creative Commons Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are credited.

Montero-Puga et al. Int J Surg Res Pract 2023, 10:157 • Page 1 of 3 •

DOI: 10.23937/2378-3397/1410157 ISSN: 2378-3397

multiple hemangiomas distributed throughout the in the umbilical region, denying nausea, vomiting, fever,
body. She comes to consult due to increased volume in pain or constipation. Physical examination, skin color
the right inguinal region for 3 years, in the left inguinal unchanged, reducible, not incarcerated, not strangled.
region for two years, both without treatment, which The diagnostic protocol was started where the presence
increased with the Valsalva maneuver and currently one of bilateral inguinal and umbilical hernia was evidenced,

Figure 1

Figure 2 Figure 3
Figure 1, Figure 2 and Figure 3: The diagnostic protocol was started where the presence of bilateral inguinal and umbilical
hernia was evidenced, for which a surgical programming was decided to perform abdominal wall plasty.

Figure 4 Figure 5
Figure 4 and Figure 5: Right and left inguinal plasty with mesh and umbilical plasty without mesh were performed.

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DOI: 10.23937/2378-3397/1410157 ISSN: 2378-3397

for which a surgical programming was decided to which can increase the risk of serious complications
perform abdominal wall plasty (Figure 1, Figure 2 and in the postoperative period, such as pulmonary
Figure 3). Right and left inguinal plasty with mesh and thromboembolism. These pathological conditions
umbilical plasty without mesh were performed (Figure should be investigated in patients with hereditary
4 and Figure 5). The patient is discharged 24 hours after collagen disorders, such as Ehlers-Danlos disease,
the procedures were performed. In her follow-up, the Marfan syndrome in its incomplete or atypical forms
patient is asymptomatic and incorporated into her daily [7,8].
activities.
Conclusion
Discussion Abdominal hernias have a multifactorial cause, such
In the last 30 years, research on the etiopathogenesis as the weakness of the wall that contains them due
of abdominal wall hernias has revealed that one of to a disease of the extracellular matrix with deficient
the causes is due to multifactorial systemic tissue collagen production, making carriers more susceptible to
disease, currently known as herniosis [1]. Defined as suffering from them and the appearance of recurrences,
a systemic disease of the connective tissue originating so that patients with multiple hernias should be studies
in the extracellular matrix and related to a deficient or looking for defects in the extracellular matrix.
abnormal production of collagen (collagenosis), or with
its accelerated or increased degradation, mediated
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