Top

Published in:

30-07-2021 | Shingles | Review Article

Abdominal Pseudohernia Secondary to Herpes Zoster: a Systematic Review

Authors: Evie Yeap, Brian Hodgkins, Thomas Surya Suhardja

Published in: Indian Journal of Surgery | Issue 4/2022

Abstract

Abdominal wall pseudohernia is an unusual complication following herpes zoster. However, it can be confused with a true hernia and should be differentiated from other causes of pseudohernia. We review the published literature to describe the evidence around presentation, investigation, management, and prognosis of this condition. A MEDLINE search was performed in October 2020. The references of identified articles were searched. Studies were included if full text was available and if one case or more of abdominal wall paralysis caused by herpes zoster was described. We identified 72 articles describing 83 cases. The following information was extracted: age, sex, timing of rash and paresis, investigations and timing and completeness of recovery. This presentation occurred more in the elderly (average age of 66.9) and in males (72.6%). The most commonly involved level was T11. In most cases (76.2%), abdominal wall paralysis occurred after the cutaneous manifestations, after an average of 27.6 days. Six patients (7.14%) presented with concurrent cutaneous symptoms and pseudohernia. Seven patients (8.33%) presented with a pseudohernia first. Electromyography was performed in 35 cases (41.7%) and 31 had an abnormal result. Multiple resonance imaging was performed in 13 cases (15.5%): 5 showed an abnormality. Forty-one patients had a complete recovery at an average of 4.29 months. Sixteen patients (19.0%) only had partial recovery. Abdominal wall pseudohernia is an unusual sequel of herpes zoster infection with pathognomonic findings. Prognosis is good with complete or partial recovery for most patients.

Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpää ML, McKendrick MW (2007) Recommendations for the management of herpes zoster. Clin Infect Dis 44(Supplement_1):S1–S26CrossRef

Chernev I, Dado D (2013) Segmental zoster abdominal paresis (zoster pseudohernia): a review of the literature. PM R 5(9):786–790. https://doi.org/10.1016/j.pmrj.2013.05.013CrossRefPubMed

Tashiro S, Akaboshi K, Kobayashi Y, Mori T, Nagata M, Liu M (2010) Herpes zoster-induced trunk muscle paresis presenting with abdominal wall pseudohernia, scoliosis, and gait disturbance and its rehabilitation: a case report. Arch Phys Med Rehabil 91(2):321–325. https://doi.org/10.1016/j.apmr.2009.10.011CrossRefPubMed

Al Rakban AM, Siddiqui MA, Awada AA, Dean CR (2000) Abdominal muscle paralysis in herpes zoster. Neurosciences (Riyadh) 5:66–68

Chiu H-Y, Lin S-J (2013) A painful bulge in the left flank. JAMA 310(6):639–640CrossRef

Curell A, Ortega N, Protti GP, Balibrea JM, Lopez-Cano M (2019) Postherpetic pseudohernia. Cir Esp 97(1):55–57. https://doi.org/10.1016/j.ciresp.2018.06.006CrossRefPubMed

Dobrev H, Atanassova P, Sirakov V (2008) Postherpetic abdominal-wall pseudohernia. Clin Exp Dermatol 33(5):677–678. https://doi.org/10.1111/j.1365-2230.2007.02657.xCrossRefPubMed

Eguchi H, Furukawa N, Tago M, Fujiwara M, Ogushi A, Tokutomi J, Choi S, Yamamoto K, Yoshihara K, Yamashita SI (2017) Temporary unilateral abdominal muscle paralysis due to herpes zoster without typical vesicles or pain. J Gen Fam Med 18(1):35–37. https://doi.org/10.1002/jgf2.20CrossRefPubMedPubMedCentral

Fujikawa T, Saito M (2019) Pseudohernia preceding disseminated herpes zoster. Lancet Infect Dis 19(2): 215CrossRef

10.

Garcia RL (1980) Segmental abdominal zoster paresis. Int J Dermatol 19(9):510–511CrossRef

11.

Guo H, Zhao CC, Gao XH, Chen HD, Li JH (2019) An unusual abdominal bulge and disseminated crusts. J Dtsch Dermatol Ges 17(1):87–89. https://doi.org/10.1111/ddg.13724CrossRefPubMed

12.

Kesler A, Galili-Mosberg R, Gadoth N (2002) Acquired neurogenic abdominal wall weakness simulating abdominal hernia. IMAJ-RAMAT GAN- 4(4):262–264

13.

Lee SH, Baek MS, Yang HD, Jahng J, Kim YS (2014) Unilateral abdominal wall paralysis by motor involvement of herpes zoster. J Korean Neurol Assoc 32(4):332–333

14.

Lewis G (1958) Zoster sine herpete. BMJ 2(5093):418CrossRef

15.

Mancuso M, Virgili MP, Pizzanelli C, Chiari A, Geri G, Michelassi MC, Galli R (2006) Abdominal pseudohernia caused by herpes zoster truncal D12 radiculoneuropathy. Arch Neurol 63(9):1327–1327CrossRef

16.

Manvi S, Sharma R (2017) Herpes zoster and motor involvement-report of 2 cases. J Med Sci Clin Res 5(12): 32176–32178

17.

McAllister RK, Borum SE, Mitchell DT, Bittenbinder TM (2002) Thoracic motor paralysis secondary to zoster sine herpete. The Journal of the American Society of Anesthesiologists 97(4):1009–1011

18.

McLoughlin R, Waldron R, Brady M (1988) Post-herpetic abdominal wall herniation. Postgrad Med J 64(756):832CrossRef

19.

Mitsutake A, Sasaki T, Hideyama T, Sato T, Katsumata J, Seki T, Maekawa R, Shiio Y (2018) Paraspinal muscle involvement in herpes zoster-induced abdominal wall pseudohernia revealed by electrophysiological and radiological studies. J Neurol Sci 385:89–91. https://doi.org/10.1016/j.jns.2017.12.019CrossRefPubMed

20.

Molinero J, Nagore E, Obon L, Miquel F, Aliaga A (2002) Metameric motor paresis following abdominal herpes zoster. Cutis 2:143–141

21.

Morera MJ, Gómez GM, Muñoz NA (2009) Abdominal muscle paralysis as a complication of herpes zoster. Rev Clin Esp 209(9):454CrossRef

22.

Morera Montes J (2018) [Paralysis of the abdominal muscles after herpes zoster. Case series]. Semergen 44(1):e71–e73. https://doi.org/10.1016/j.semerg.2017.04.006CrossRefPubMed

23.

Muramatsu K, Ujiie H, Shimizu H (2017) Postherpetic abdominal pseudohernia. BMJ. https://doi.org/10.1136/bmj.j2786CrossRef

24.

Nakagawa H, Miyata Y (2021) Ipsilateral abdominal bulge caused by postherpetic pseudohernia. Am J Gastroenterol 116(6):1116

25.

Ohno S, Togawa Y, Chiku T, Sano W (2016) Postherpetic pseudohernia: delayed onset of paresis of abdominal muscles due to herpes zoster causing an ipsilateral abdominal bulge. BMJ Case Rep 2016:1–3

26.

Oliveira PD, dos Santos Filho PV, de Menezes Ettinger JE, Oliveira IC (2006) Abdominal-wall postherpetic pseudohernia. Hernia 10(4):364–366. https://doi.org/10.1007/s10029-006-0102-6 (discussion 293)CrossRefPubMed

27.

Ranjan S, Sood RG (2017) Phantom hernia due to abdominal herpes zoster. Int J Health Sci Res 7(9):338–339

28.

Riopelle A, Kim D, Dayal A (2020) Spontaneous resolution of abdominal pseudohernia after herpes zoster. Am J Med 133(3):e102–e103. https://doi.org/10.1016/j.amjmed.2019.08.026CrossRefPubMed

29.

Ruiz Junior FB, Shinosaki JSM, Marques Junior W, Ferreira MS (2007) Abdominal wall protrusion following herpes zoster. Rev Soc Bras Med Trop 40(2):234–235CrossRef

30.

Santiago-Perez S, Nevado-Estevez R, Perez-Conde MC (2012) Herpes zoster-induced abdominal wall paresis: neurophysiological examination in this unusual complication. J Neurol Sci 312(1–2):177–179. https://doi.org/10.1016/j.jns.2011.08.035CrossRefPubMed

31.

Schuchmann JA, McAllister RK, Armstrong CS, Puana R (2008) Zoster sine herpete with thoracic motor paralysis temporally associated with thoracic epidural steroid injection. Am J Phys Med Rehabil 87(10):853–858. https://doi.org/10.1097/PHM.0b013e318186c049CrossRefPubMed

32.

Seto-Torrent N, Iglesias-Sancho M, Arandes-Marcocci J, Salleras Redonnet M (2020) Abdominal pseudohernia due to herpes zoster. Actas Dermosifiliogr 111(9):790–792. https://doi.org/10.1016/j.ad.2019.01.029CrossRefPubMed

33.

Shikino K, Miyahara M, Noda K, Ohira Y, Ikusaka M (2016) Unilateral lower abdominal wall protrusion and umbilical deviation. Clin Case Rep 4(4):451–452. https://doi.org/10.1002/ccr3.524CrossRefPubMedPubMedCentral

34.

Tan SM, Sek KS, Teng GG (2020) Herpes zoster-associated abdominal pseudohernia. Am J Med. https://doi.org/10.1016/j.amjmed.2020.07.028CrossRefPubMed

35.

Tirelli LL, Luna PC, Larralde M (2019) Postherpetic abdominal pseudohernia. Presentation of a clinical case and literature review. Int J Dermatol 58(4):497–499. https://doi.org/10.1111/ijd.14146CrossRefPubMed

36.

Tjandra J, Mansel R (1986) Segmental abdominal herpes zoster paresis. Aust N Z J Surg 56(10):807–808CrossRef

37.

Yagi Y, Matono T, Nakamura K, Imura H (2018) Postherpetic abdominal pseudohernia: a diagnostic pitfall. J Gen Fam Med 19(1):36–37. https://doi.org/10.1002/jgf2.147CrossRefPubMed

38.

Yoo J, Koo T, Park E, Jo M, Kim MS, Jue MS (2019) Abdominal pseudohernia caused by herpes zoster: 3 case reports and a review of the literature. JAAD Case Rep 5(8):729–732. https://doi.org/10.1016/j.jdcr.2019.06.019CrossRefPubMedPubMedCentral

39.

Yu YH, Lin Y, Sun PJ (2019) Segmental zoster abdominal paresis mimicking an abdominal hernia: a case report and literature review. Medicine (Baltimore) 98(15):e15037. https://doi.org/10.1097/MD.0000000000015037CrossRef

40.

Zuckerman R, Siegel T (2001) Abdominal-wall pseudohernia secondary to herpes zoster. Hernia 5(2):99–100. https://doi.org/10.1007/s100290100005CrossRefPubMed

41.

Azimi SZ, Firooz A (2020) Postherpetic abdominal pseudohernia: an uncommon complication of herpes zoster. Dermatol Ther 33(4):e13530. https://doi.org/10.1111/dth.13530CrossRefPubMed

42.

Bashir U, Anwar MI, Tahir M (2016) Postherpetic pseudohernia of abdominal wall: a case report. J Pak Assoc Dermatol 24(4):355–357

43.

Bloedorn W, Roberts L (1924) Herpes zoster with motor paralysis. J Am Med Assoc 82(8):622–623CrossRef

44.

Giuliani A, Galati G, Parisi L, Ricciardulli T, Bartolo M, Tartaglia E, Grimaldi M, Pranteda G (2006) Postherpetic paresis mimicking an abdominal herniation. Acta Derm Venereol 86(1):73–74. https://doi.org/10.1080/00015550510042886CrossRefPubMed

45.

Gottschau P, Trojaborg W (1991) Abdominal muscle paralysis associated with herpes zoster. Acta Neurol Scand 84(4):344–347CrossRef

46.

Hashimoto T, Aoki T, Hirayama Y, Horitani R (2020) Segmental zoster abdominal paresis without skin rash. Intern Med. https://doi.org/10.2169/internalmedicine.5625-20CrossRefPubMedPubMedCentral

47.

Kim SY, Lee KS, Kwon NH, Kim SH, Joh JS, Bang JH (2009) A case of unilateral abdominal protrusion following cutaneous zoster. Korean J Med 77(1):236–239

48.

Lee J-H, Heo H-j, Kim I, Shin SI (2018) Abdominal muscle paresis due to herpes zoster with hiatal hernia-a case report. Anesth Pain Med 13(2):197–200. https://doi.org/10.17085/apm.2018.13.2.197CrossRef

49.

Lee JY, Sunwoo JS, Kwon KY, Lee KB, Ahn MY, Roh H (2019) Postherpetic pseudohernia: lesion localization using thoracic spine magnetic resonance imaging. J Clin Neurol 15(2):262–264. https://doi.org/10.3988/jcn.2019.15.2.262CrossRefPubMedPubMedCentral

50.

Lee SW, Song SE, Kim KJ, Heo EP (2016) Abdominal pseudohernia following herpes zoster. J Korean Geriatr Soc 20(1):61–63. https://doi.org/10.4235/jkgs.2016.20.1.61CrossRef

51.

Liu XK, Li J (2018) Muscle weakness related to herpes zoster. CMAJ 190(3):E81. https://doi.org/10.1503/cmaj.171209CrossRefPubMedPubMedCentral

52.

Park SH, Lee S-H (2017) Segmental zoster abdominal paresis (zoster pseudohernia) preceding a skin rash. Eur J Dermatol 27(5):534–535CrossRef

53.

Tago M, Aihara H, Yamashita S (2017) Unilateral abdominal bulge with sharp pain. Eur J Intern Med 43:e7–e8. https://doi.org/10.1016/j.ejim.2017.02.015CrossRefPubMed

54.

Zhou S-R, Liu C-Y (2012) A case report of abdominal distention caused by herpes zoster. World J Gastroenterol: WJG 18(33):4627CrossRef

55.

Baveja S, Sharma Y, Rao P (2003) Lumbar hernia following herpes zoster. Indian J Dermatol Venereol Leprol 69(7):21

56.

Dobrev HP, Atanassova PA, Sirakov VN, Zisova LG (2012) A case of rheumatoid arthritis presenting with postherpetic neuralgia and abdominal-wall pseudohernia. Rheumatol Int 32(6):1775–1777. https://doi.org/10.1007/s00296-009-1360-2CrossRefPubMed

57.

Füessl H (2013) Pseudohernie durch Zoster. MMW-Fortschritte der Medizin 155(9):32–32CrossRef

58.

Glantz R, Ristanovic R (1988) Abdominal muscle paralysis from herpes zoster. J Neurol Neurosurg Psychiatry 51(6):885CrossRef

59.

Hori H, Fukuchi T, Sugawara H (2020) At-a-glance diagnosis of postherpetic abdominal pseudohernia. Int J Infect Dis 95:371–372. https://doi.org/10.1016/j.ijid.2020.03.079CrossRefPubMed

60.

Hung CT, Wang WM (2012) Postherpetic pseudohernia. CMAJ 184(3):E202.

61.

Juergens H (1924) Herpes zoster with motor paralysis. J Am Med Assoc 82(17):1342–1342CrossRef

62.

Kim HH, Son HJ, Yoon SK, Shin JW, Leem JG (2008) Unilateral Abdominal protrusion developed in diabetic patient after postherpetic neuralgia. Korean J Pain 21(3):233–236

63.

Maeda K, Furukawa K, Sanada M, Kawai H, Yasuda H (2007) Constipation and segmental abdominal paresis followed by herpes zoster. Intern Med 46(17):1487–1488. https://doi.org/10.2169/internalmedicine.46.0328CrossRefPubMed

64.

Masten MG (1927) Herpes zoster with paralysis of abdominal muscles and postherpetic neuralgia. Arch Neurol Psychiatry 18(3):437–439CrossRef

65.

Nair PA, Pariath K (2018) Abdominal wall herniation after herpes zoster. Indian Dermatol Online J 9(4):278–279. https://doi.org/10.4103/idoj.IDOJ_224_17CrossRefPubMedPubMedCentral

66.

Miranda-Merchak A, Garcia N, Vallejo R, Varela C (2018) MRI findings of postherpetic abdominal wall pseudohernia: a case report. Clin Imaging 50:109–112. https://doi.org/10.1016/j.clinimag.2018.01.004CrossRefPubMed

67.

Pulia MS, Sielaff A, Calderone M (2012) Images in emergency medicine. Postherpetic pseudohernia. Ann Emerg Med 60(1):11–32. https://doi.org/10.1016/j.annemergmed.2011.11.042CrossRefPubMed

68.

Sakamoto S, Suyama Y, Sugita M (2020) A woman with abdominal swelling. Emerg Med J 37(1):18–24CrossRef

69.

Tagg NT, Tsao JW (2006) Images in clinical medicine. Abdominal pseudohernia due to herpes zoster. N Engl J Med 355(1):e1. https://doi.org/10.1056/NEJMicm050341CrossRefPubMed

70.

Sharma P, Gautam R, Basistha C, Jain R, Kar H (2001) Abdominal hernia following abdominal herpes zoster. Indian J Dermatol Venereol Leprol 67(1):39PubMed

71.

Thakur V, Kumar S, Narang T (2019) Postherpetic pseudohernia. Postgrad Med J 95(1129):625. https://doi.org/10.1136/postgradmedj-2019-136927CrossRefPubMed

72.

Worster-Drought C (1923) Herpes zoster with localized muscular paralysis. BMJ 1(3258):970CrossRef

73.

Tsukita K, Sakamaki-Tsukita H (2019) Abdominal Wall Pseudohernia and Colonic Pseudo-obstruction as Complications of Herpes Zoster. Clin Gastroenterol Hepatol 17(4):A26. https://doi.org/10.1016/j.cgh.2018.04.051CrossRefPubMed

74.

Wright AD Herpes zoster involving left quadratus lumborum and oblique muscles, with complete reaction of degeneration. Lumbar pseudo-hernia in region of scars. Proc Royal Soc Med 48:1116

75.

Stetkarova I, Chrobok J, Ehler E, Kofler M (2007) Segmental abdominal wall paresis caused by lateral low thoracic disc herniation. Spine 32(22):E635–E639CrossRef

76.

Butenschoen VM, Hoenikl L, Deschauer M, Meyer B, Gempt J (2020) Bilateral thoracic disc herniation with abdominal wall paresis: a case report. Acta Neurochir 162(9):2055–2059. https://doi.org/10.1007/s00701-020-04431-5CrossRefPubMed

77.

Bárbara-Bataller E, Martín del Rosario F, Méndez-Suárez JL, Alemán-Sánchez C, Sosa Henríquez M (2018) Abdominal pseudohernia after spinal cord injury: report of three cases. Cirugía Española (English Edition) 96(9):587–589. https://doi.org/10.1016/j.cireng.2018.10.008CrossRef

78.

Butensky AM, Gruss LP, Gleit ZL (2016) Flank pseudohernia following posterior rib fracture: a case report. J Med Case Rep 10(1):273. https://doi.org/10.1186/s13256-016-1054-9CrossRefPubMedPubMedCentral

79.

Dakwar E, Le TV, Baaj AA, Le AX, Smith WD, Akbarnia BA, Uribe JS (2011) Abdominal wall paresis as a complication of minimally invasive lateral transpsoas interbody fusion. Neurosurg Focus 31(4):E18. https://doi.org/10.3171/2011.7.FOCUS11164CrossRefPubMed

80.

Durham-Hall A, Wallis S, Butt I, Shrestha BM (2009) Abdominal wall pseudohernia following video-assisted thoracoscopy and pleural biopsy. Hernia 13(1):93–95. https://doi.org/10.1007/s10029-008-0401-1CrossRefPubMed

81.

Chiu HK, Trence DL (2006) Diabetic neuropathy, the great masquerader: truncal neuropathy manifesting as abdominal pseudohernia. Endocr Pract 12(3):281–283CrossRef

82.

Chakraborty PP, Singha A, Bhattacharjee R, Chowdhury S (2016) Abdominal pseudohernia: a manifestation of diabetic truncal radiculoneuropathy. BMJ Case Rep 2016:1–2. https://doi.org/10.1136/bcr-2016/215605

83.

Weeks R, Thomas P, Gale A (1999) Abdominal pseudohernia caused by diabetic truncal radiculoneuropathy. J Neurol Neurosurg Psychiatry 66(3):405–405CrossRef

Title: Abdominal Pseudohernia Secondary to Herpes Zoster: a Systematic Review
Authors: Evie Yeap
Brian Hodgkins
Thomas Surya Suhardja
Publication date: 30-07-2021
Publisher: Springer India
Keywords: Shingles
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Computed Tomography
Computed Tomography
Published in: Indian Journal of Surgery / Issue 4/2022
Print ISSN: 0972-2068
Electronic ISSN: 0973-9793
DOI: https://doi.org/10.1007/s12262-021-03056-x

At a glance: The STEP trials

Springer Medicine

Abdominal Pseudohernia Secondary to Herpes Zoster: a Systematic Review

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2022

Meta-analysis and Systematic Review in Patients with Locally Advanced Rectal Cancer with Total Mesorectal Excision (TME) Alone and TME Combined with Extended Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy

One Man—Six Spleens

Effects of Music on Pain and Autonomic Functions of Heart Rate, Blood Pressure, Nausea and Vomiting After Major Surgery—Meta-analysis

Laparoscopic Ventral Mesh Rectopexy with Resection of Dolichocolon for Treatment of Obstructed Defecation Syndrome: Technical Report

On the Way to Improve Diagnostic Marker Panel for Acute Appendicitis in Adults: the Role of Calprotectin

Malignant Phyllodes Tumor Complicating Precious Pregnancy—Management Dilemma