Patients usually present clinically with abdominal pain, abdominal distension, a palpable soft-tissue mass, nausea, and vomiting. Abdominal radiography or CT scan of the abdomen and pelvis can help the physician reach a diagnosis by delineating the defect of the iliac crest, defining the fascial planes, and displaying the contents of the herniated sac.
12 Hernias may contain retroperitoneal fat, kidneys, spleen, liver, and bowel.
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Regarding the current case, we later discovered a radiograph obtained 2 years after bone grafting, taken after an unrelated fall on the ice 1 year before presentation. The radiograph showed an opening in the iliac crest at the donor graft site that was not described in the radiologist’s report. This finding highlights the need to make both patients and health care professionals aware of possible adverse events related to donor grafts and encourage them to monitor those sites proactively.
Typically, patients' medical and surgical history and clinical presentation should guide the focused structural examination. In particular, examining physicians should observe patients as they enter the room, noting gait and posture, using structural examination to detect any asymmetrical abnormalities, and palpating the area in question for any changes, defects, or discomfort. The examination should include the innominate, sacroiliac dysfunctions, and soft-tissue changes. Had our patient’s previous operation been reported to her primary care physician, that physician could have monitored the operation site for potential herniation. This extra attention would have prompted elective repair when the hernia was first detected, obviating the need for an emergency operation.