Incarceration Of Inguinal Hernia Research Articles

Predictivity of aspartate aminotransferase to alanine aminotransferase (De Ritis) ratio for detecting bowel necrosis in incarcerated inguinal hernia patients.

Early diagnosis of necrotic bowel segment resulting from incarcerated inguinal hernia (IIH) is crucial for reducing morbidity and mortality. The aim of this study was to investigate the efficacy of the De Ritis ratio (DRR), also known as the ratio of aspartate aminotransferase to alanine aminotransferase, as a biomarker for intestinal necrosis. This retrospective study included 132 patients who underwent emergency surgery for IIH. Patients were divided into two groups: those who underwent bowel resection for necrosis (Group 1) and those who did not (Group 2). Patients' demographic and clinical data were recorded. Using laboratory test results, DRR, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and lymphocyte-to-CRP ratio (LCR) were calculated. The morbidity and mortality rates and the length of stay for Group 1 were statistically significantly different (p < 0.0001). The DRR, NLR, PLR, LMR, and LCR values of the same group were also significantly different (p < 0.05). DRR can be used as a biomarker for early diagnosis of bowel necrosis in patients with IIH.

Neonatal Incarceration of Inguinal Hernia with Torsion of Right Testes

An inguinal hernia is a bulge or protrusion that is seen or felt in the groin area or the scrotum (for boys). Inguinal hernias occur in boys more frequently than in girls. Infants who are born prematurely are at an increased risk of having an inguinal hernia. Incarceration of hernia is a major problem in neonates, it causes significant pain and the content of this hernia is the intestine. If not diagnosed early it causes a cut in the blood supply and the infant became very sick. Treatment of inguinal hernia is surgical under general anesthesia, but if an inguinal hernia is present in preterm the surgical will be done before discharge. Bilateral inguinal hernia in females must be investigated very carefully, maybe ovaries are present in inguinal hernia.

Laparoscopic versus Open Incarcerated Inguinal Hernia Repair in Children: A Systematic Review and Meta-Analysis.

Laparoscopic hernia repair (LH) is reported to have superior outcomes in pediatric inguinal hernia repair, but its advantages in incarcerated inguinal hernia (IIH) are not defined. We compare the outcomes of LH versus open hernia repair (OH) for pediatric IIH. We performed a systematic review on all published analyses of LH versus OH for IIH. We identified studies published in 2000 to 2018 from Medline, PubMed, Embase, Google Scholar, and Cochrane databases. We included only studies that compared both surgical techniques on children aged 18 years or younger. Search terms were variations of "incarcerated inguinal hernia," "hernia repair," "laparoscopy," and "child." We categorized complications as major (testicular atrophy, ascending testis, recurrence, iatrogenic visceral injury) and minor (wound infection). Heterogeneity was assessed using I2; meta-analyses were performed using random- or fixed-effects models as appropriate. Weighted mean differences (WMDs) or odds ratios (ORs), with their corresponding 95% confidence intervals (CIs), were used for analysis of continuous and dichotomous variables, respectively. Significance level was at p-value less than 0.05. Our initial search yielded 549 unique citations. Eight retrospective cohort (RC) studies (584 patients) were included in the final analysis (339 LH, 245 OH). Overall, major complications (eight RC; n = 584; OR = 0.38; 95% CI: 0.17-0.88; p = 0.02) were more common in OH. When each complication was assessed individually, there were no differences between groups. The length of hospital stay in the LH group was shorter than in the OH group (five RC; n = 418; WMD = - 1.39; 95% CI, -2.56 to -0.22; p = 0.02). Laparoscopic repair for IIH is associated with less major complications and shorter hospital stay, but data are limited due to the absence of randomized controlled trials.

A predictive model of bowel resection for incarcerated inguinal hernia based on the systemic immune-inflammation index.

Background and PurposeAn inguinal hernia is a common surgical disease. Once incarcerated or strangulated, it may endanger the life of the patient. Therefore, it is essential to study the risk factors of incarcerated inguinal hernia (IIH) and strangulated inguinal hernia (SIH). One of the serious complications of IIH and SIH is intestinal necrosis, which occurs owing to blood supply disorder. The study explores the risk factors of intestinal resection and establishes a simple model to assess the incidence of intestinal resection to provide significant assistance and limited guidance for clinical work.Patients and MethodsOur research team collected and retrospectively analysed the clinical data of 338 patients with IIH who were hospitalized in the First Affiliated Hospital of Wenzhou Medical University between September 2008 and December 2016. According to the surgical plan, we divided the included cases into two groups, non-intestinal and intestinal resection groups, and the clinical case characteristics of these groups were statistically analysed.ResultsBased on multivariable logistic regression analysis, we found that increased risk of bowel resection was highly correlated among the elderly (≥70 years), and for people with high temperature (≥37.3°C), high systemic immune-inflammation index(SII) values (≥1230.13), presence of bowel obstruction, and signs of peritonitis. Further, we processed the five independent risk factors using special software to obtain a simple model called a nomogram. To verify the nomogram’s accuracy and predictive ability, we calculate the C-index: 0.806 and use the calibration curve to evaluate its stability and predictive performance. We constructed the ROC curve nomogram and other sub-variables, and calculated the area under the curve (AUC) corresponding to the nomogram (AUC = 0.808, 95% CI = 0.762 to 0.848), SII (AUC = 0.752, 95% CI = 0.703 to 0.797), age (AUC = 0.641, 95% CI = 0.587 to 0.692), temperature (AUC = 0.579, 95% CI = 0.524 to 0.632), bowel obstruction (AUC = 0.685, 95% CI = 0.633 to 0.734), and signs of peritonitis (AUC = 0.580, 95% CI = 0.525 to 0.633).ConclusionIt can be said that we found for the first time that clinical variables such as SII are independent risk factors for enterectomy for IIH. The nomogram based on SII and other variables can accurately and easily predict the probability of IIH requiring bowel resection.

Amyand's Hernia as a Random Finding in Acute Abdominal Pain and the Role of Thorough Investigation: a Case Report.

Objective:Amyand's hernia is a rare clinical entity, in which the sac of an inguinal hernia contains the appendix. Its incidence is less than 1% of all inguinal hernia cases. Clinical presentation is not specific and can mislead clinical suspicion towards inguinal hernia incarceration. Different classifications have been proposed, with significant importance for the surgical management plan. The main factors to take into consideration include hernia sac content and macroscopic appearance of the appendix, intra-abdominal inflammation, the possibility of hernia recurrence, and patient's general situation and comorbidities. Materials and methods: A 60-year-old male patient with previous history of tension-free right inguinal hernia repair with mesh and cholelithiasis presented to the Emergency Department complaining of acute abdominal pain localized at the right lumbar and right iliac region and a right groin easily reducible mass. The patient had an abdominal CT performed 48 hours ago that revealed cholelithiasis and a recurrent right inguinal hernia containing the appendix. Because of the consistent pain in the right abdomen despite the easily reducible hernia, a high suspicion of a coexisting pathology was raised and a new abdominal CT scan with intravenous and per os contrast agent was ordered. The latter showed an Amyand's hernia and cholelithiasis, but also detected lithiasis of the right ureter with upstream dilatation as the main cause of abdominal pain. Results:The patient was subsequently treated with ureteral stent placement and the following day laparoscopic hernia repair with a transabdominal preperitoneal (TAPP) approach and cholecystectomy were performed. The patient was discharged from hospital on the second postoperative day without complications. Conclusion:Surgeons should be aware of different types of Amyand's hernia and have to include this entity in the differential diagnosis of right iliac fossa abdominal pain combined with a groin mass to avoid intraoperative complications and suboptimal management. It is equally important, though, to exclude other causes of abdominal pain. This case report reviews a rare entity of right inguinal hernia recurrence presenting as Amyand's hernia during the investigation of right abdominal and iliac fossa pain, that was finally attributed to ureteric colic. Special attention should be given to the thorough investigation of abdominal pain causes.

Nomogram for the Estimation of Intestinal Necrosis Risk in Incarcerated Inguinal Hernia in Infants under 6 Months.

This article develops a nomogram to estimate intestinal necrosis risk in the incarcerated inguinal hernia (IIH) in infants under 6 months. A total of 273 infants who underwent an emergency operation due to IIH were investigated retrospectively. Univariate and multivariate logistic regression were used to analyze the relationship between variables and intestinal necrosis and construct a nomogram of intestinal necrosis. The discrimination and concordance of the model were verified by receiver operating characteristic (ROC) analysis and calibration curve, and the bootstrap method was used for internal validation of the model. The clinical applicability of the model was evaluated using the decision curve and the clinical impact curve. Intestinal necrosis was found in 37 of 273 infants (13.6%) in this study. The vomiting symptoms, platelet count, C-reactive protein, and neutrophil-lymphocyte ratio were independent risk factors for intestinal necrosis in IIH. We then constructed a nomogram with these four factors. ROC analysis showed that the nomogram had a good diagnostic performance, with the area under the curve (AUC), sensitivity, and specificity of 0.918 (95% confidence interval: 0.880-0.956), 97.3%, and 69.9%, respectively. The nomogram was further validated using 2,000-repetition internal bootstrap validation, and the values of AUC, sensitivity, and specificity were 0.899, 95.7%, and 50.5%, respectively. The decision curve and the clinical impact curve indicated that the predictive model has a favorable clinical application. The nomogram can be used to predict intestinal necrosis in IIH, and allow us to estimate the severity of IIH more accurately and arrange the treatment process more reasonably.

Inguinal Hernia Incarceration Associated with Cryptorchidism in an Adult with Poland's Syndrome—A Case Report—

症例は出生時に右胸部，右手指の手術歴がある82歳の男性．腹痛・嘔吐を主訴に近医を受診し，右鼠径ヘルニア嵌頓，腸閉塞の診断で嵌頓整復後当院へ紹介となった．画像検査，身体所見では上記診断に加えて右陰嚢内に精巣を認めず，ヘルニア嚢近傍の皮下に精巣と思われる腫瘤を認めた．また，右手指，右胸郭の変形，異常骨，左片腎，腸回転異常を認めた．以上よりPoland症候群，右停留精巣，右鼠径ヘルニアと診断した．術中所見ではヘルニア嚢は陰嚢方向に伸びず，外鼠径輪を出て頭外側に走行し，外腹斜筋腱膜の腹側の皮下で停止していた．精巣はヘルニア嚢の盲端付近に認め，精巣摘出術，ヘルニア修復術を施行した．停留精巣は男性において多く認められる先天異常であるが，多くは1～2歳までに手術加療されており，成人で認めることは少ない．成人停留精巣を合併する鼠径ヘルニアも少なく，Poland症候群という先天異常も合併するのはさらに稀と考えられる．

Single Incision Laparoscopic Percutaneous Extraperitoneal Closure of Internal Ring for Incarcerated Inguinal Hernia in Children: A Single Center Experience with 104 Cases.

Introduction: The aim of this report is to present our technique and outcomes of single incision laparoscopic percutaneous extraperitoneal closure of internal ring (SILPEC) for incarcerated inguinal hernia (IIH) in children. Patients and Methods: The medical records of all children undergoing emergency SILPEC for IIH after unsuccessful attempted manual reduction between June 2016 and September 2020 at our center were reviewed. For SILPEC, two trocars 3.5-6 mm were placed through a single umbilical incision. A 17G epidural needle and a small wire-lasso were used for extraperitoneal closure of the internal ring. Results: From a total of 2904 consecutive patients with inguinal hernia (IH) undergoing SILPEC, 104 patients (3.6%) had IIH. There were 84 boys and 20 girls with a median age of 18.5 months (ranged 1 month to 11 years). At the time of surgery under general anesthesia IIH was found to be spontaneously reduced in 26.9%; the hernia contents were bowel in 52.9%, great omentum in 13.5%, and ovary in 6.7% of the patients. All hernias were successfully reduced without additional ports or conversion to open surgery. Patent contralateral processus vaginalis (PCPV) was detected intraoperatively in 44.2% of the cases. The median operative time was 24 minutes for unilateral and 30 minutes for bilateral procedures. The median postoperative stay was 1 day. At a median follow-up of 28 months, there was no case of hydrocele, testicular atrophy, or iatrogenic cryptorchism. The postoperative cosmesis was excellent as all patients were virtually scarless. Recurrence occurred in 1.9% with no significant difference (P = .669) compared to the 1.4% recurrence rate of the 2800 patients with ordinary IH undergoing elective SILPEC during the same study period. Conclusions: SILPEC for IIH in children is feasible, safe, with excellent postoperative cosmesis, and no significant difference in hernia recurrence between emergency SILPEC for IIH and elective SILPEC for ordinary IH.

İnflamatuar belirteçler inkarsere inguinal hernilerde barsak nekrozunu öngörebilir mi?

Aim: To evaluate the predictive or diagnostic value of inflammatory markers in the presence of bowel necrosis in patients with an incarcerated inguinal hernia.&#x0D; Material and Methods: The sample consisted of 246 patients that were admitted to the Emergency Service of Ankara Numune Training and Research Hospital and were operated on between January 2013 and January 2018 with a diagnosis of incarcerated inguinal hernia (IIH). The electronic patient records were screened to obtain the blood test results pertaining to lymphocyte count, neutrophil count, neutrophil/lymphocyte ratio (NLR), red cell distribution width (RDW), platelet count, and RDW/platelet ratio; surgical notes concerning resection status and inguinal hernia type; and demographic data. The patients included in the study were divided into two groups as those that had received a bowel resection and those that had not undergone this procedure.&#x0D; Results: Of the 246 patients, 159 (65%) were male and 87 (35%) were female. The median age (interquartile range) was 71 (66-78) years and 62 (50-74) years in the resection (n= 23) and non-resection (n= 223) groups, respectively. There was a statistically significant difference between the two groups in terms of age (p= 0.004), neutrophil count (0.001), NLR (p= 0.000), and lymphocyte count (0.000). The multivariate analysis revealed that NLR (odds ratio= 1.113, 95% confidence interval value: 1.055-1.175, and p= 0.000) was individually, independently and significantly associated with bowel resection. &#x0D; Conclusion: Considering that it is possible to prevent the strangulation of a hernia in patients with IIH, urgent surgery is recommended for patients with an NLR of &gt; 6.5.

Laparoscopic surgical treatment for hydrocele of canal of Nuck: A case report and literature review

BackgroundHydrocele of canal of Nuck (HCN) is a rare disease in adult female. The diagnosis and treatment of HCN is still a challenge for surgeons.Case presentationA 56-year-old female presented with recent onset of occasional pain during exercise and an asymptomatic left groin swelling. Ultrasonography results were suspicious for left inguinal hernia incarceration and computed tomography (CT) scan showed no intestinal obstruction, which was considered as HCN. Laparoscopic hydrocelectomy of the HCN and a routine laparoscopic hernia repair via the transabdominal preperitoneal (TAPP) approach were performed. Postoperative pathology showed no malignant lesions or endometriosis.ConclusionsThe preoperative diagnosis of HCN is extremely important. Surgeons should choose appropriate surgical methods for different anatomical HCNs based on the preoperative diagnosis.

Feasibility of Laparoscopic Transabdominal Preperitoneal Hernioplasty for Incarcerated Inguinal Hernia.

Background/Objectives:An incarcerated inguinal hernia (IncIH) is defined as an irreducible inguinal hernia. The problems caused by long-term incarceration are adhesion between the incarcerated organ and hernial sac and difficulty in reduction of the edematous incarcerated organ. The present study was performed to evaluate the feasibility of laparoscopic transabdominal preperitoneal (TAPP) hernioplasty to treat chronic IncIH.Methods:This retrospective study included 154 patients aged >20 years who were treated for IncIH from January 1, 2015 to October 31, 2020. Patients were categorized into those with symptoms for ≥ 3 months (chronic IncIH group, 134 patients) and those with symptoms for < 3 months (acute IncIH group, 20 patients).Results:The type of incarcerated organ differed between groups. The most frequently incarcerated organ was the intestine (85%, 17/20) in the acute IncIH group and the omentum (98%, 131/134) in the chronic IncIH group (p < 0.000). Compared with the chronic IncIH group, the acute IncIH group had a higher prevalence of pre-operative inguinal pain (85%, 17/20 vs 3%, 4/134; p < 0.000) and a lower prevalence of adhesion between the incarcerated organ and the hernial sac (5%, 1/20 vs 37%, 49/134; p = 0.011). Organ resection was performed in 1 patient in the acute IncIH group and 19 in the chronic IncIH group.Conclusion:In patients with chronic IncIH, TAPP hernioplasty was used to successfully resolve adhesion between the incarcerated organ and the hernial sac, avoiding organ resection by enabling intra-abdominal reduction in many patients. TAPP hernioplasty may be a feasible surgical method for the treatment of IncIH.

A rare case of spontaneous scrotal enterocutaneous fistula as a complication of incarcerated inguinal hernia with review of literature.

Inguinal hernias are one of the most common problems presenting in both adult and pediatric surgical departments. Normally hernia is easy to diagnose and manage. On the other hand if its presence is ignored and surgery is delayed, hernia related morbidity can increase significantly. In developing countries, these complications are seen more often as there is more ignorance, illiteracy, lack of health facilities. We present a rare case of entero cutaneous fistula in scrotum due to a complete indirect inguinal hernia incarceration. There have been very few such cases that have been like this and reported so far.

ANALYSIS OF PROSTHETIC MESH REPAIR IN OBSTRUCTED INGUINAL HERNIA

Aims and objectives: The basic aim of the study is to analyse the prosthetic mesh repair in ob- structed inguinal hernia. Material and methods: This cross sectional study was performed with 70 patients who had been admitted to our hospital’s emergency department between January 2019 to August 2019, to undergo surgery for a diagnosis of obstructed inguinal hernia. Patients who died in the postoper- ative period due to systemic complications, as well as those who were lost during the follow-up period, were excluded from the study. The patients were di- vided into two groups based on the applied surgical technique. Results: Mesh-based repair techniques were performed on the 35 patients comprising Group 1, while tissue repair techniques were performed on the 35 patients comprising Group 2. In this study, 81.5% of the patients were male, while 18.5% were female. Female patients had a significantly higher ra- tio of femoral hernia than male patients, while male patients had a significantly higher ratio of inguinal hernia than female patients. In Group 3 (table 1), 6.7% (1) of the patients had wound infections, while 6.7% hematomas, 6.7% had seromas, and none had relapses. In Group 4, 7.2% of the patients had wound infections, while 1% had hematomas, 3% had sero- mas, and 1% had relapses. Conclusion: It is conclud- ed that the use of polypropylene mesh in incarcer- ated inguinal hernia repair has no negative effect on wound infection or complications. INTRODUCTION: Inguinal hernia is a commonly en- countered urgent condition in surgical clinics. An ab- dominal wall hernia is a protrusion of the abdominal tissues or organs through a weakness in the muscu- lar structure of the wall of the abdomen. Inguinal and femoral hernias are usually classified together as groin hernias [1]. It is believed that the prevalence of groin hernias in a population varies between 3% and 8%. Between 75% and 85% of all hernias are ob- served in men. Inguinal hernias account for 80– 83% of all hernias (59% indirect inguinal hernias, 25% di- rect inguinal hernias, 5% femoral hernias). The most common hernias in both genders is inguinal hernia; however, femoral hernias are reported to be more common in women than in men [2]. Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve pa- tient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair [3]. They have been endorsed by all five continental hernia societ- ies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. Ingui- nal hernia is a commonly encountered urgent condi- tion in surgical clinics. Incarcerated inguinal hernia is a commonly encountered urgent surgical condition, and tension free repair is a well-established meth- od for the treatment of non-complicated cases [4]. However, due to the risk of prosthetic materialrelat- ed infections, the use of mesh in the repair of stran- gulated or incarcerated hernia has often been the subject of debate. Recent studies have demonstrat- ed that biomaterials represent suitable materials for performing urgent hernia repair [5]. Certain studies recommend mesh repair only for cases where no bowel resection is required; other studies, however, recommend mesh repair for patients requiring bow-

Delaying surgery for inguinal hernia in neonates: Is it worthwhile?

ObjectiveThe incidence of inguinal hernia is high in premature infants; however, surgical repair is a high-risk procedure for these patients. The timing of hernia repair is still controversial. This study aimed to determine the optimal timing for inguinal herniotomy in neonates in a general hospital.MethodsA prospective cohort study was conducted from March 2014 to September 2018. A total of 127 neonates and preterm infants were admitted to the paediatric surgery clinic with uncomplicated inguinal hernia. Herniotomy was performed in all neonates, and the patients were followed up for up to 8 months after surgery for perioperative and postoperative complications. The timing of surgery was based on the surgeon's decision along with the consent of the family to the surgical intervention.ResultsOf 118 neonates, as many as 53 (45%) underwent early repair and 65 (55%) underwent late repair of inguinal hernia. The demographic data were similar between the 2 groups with no significant difference. There were no significant differences in the incidence of inguinal hernia incarceration and hydrocele formation (p = 0.11 and p = 0.8, respectively); however, there was a higher incidence of inguinal hernia recurrence (p = 0.05) and postoperative apnoea (p = 0.02) in the early repair group.ConclusionSurgical repair of inguinal hernia is feasible with low morbidity in preterm babies. The risk of hernia incarceration and testicular atrophy did not increase with delayed elective hernia repair in neonates. Delayed hernia repair decreased the risk of perioperative and postoperative complications. This study recommends delaying elective hernia repair in neonates and preterm babies.

Risk of incarceration of inguinal hernias among paediatric patients awaiting elective surgery at the University Teaching Hospital, Lusaka, Zambia

&#x0D; Background: This study was conducted to determine our own institutional rate and risk of inguinal hernia incarceration among infants and children awaiting elective surgery. Inguinal hernias in infants and children are very common. One of their common complications before surgery is incarceration. Rate and risk ofincarceration among our patients awaiting surgical care was not known.&#x0D; Method: A retrospective review of infants and children under the age of 17 years, who had undergone inguinal hernia repair or had incarcerated, from January 2015 to January 2017 was performed. Interviewer completed questionnaires were used to abstract data from the clinical records. A total of 364 patients were includedfor analysis, in this study. Descriptive statistics, Regression Analysis and Kaplan Meiers Survival Analysis were employed.&#x0D; Results: The infants and children were stratified into seven age groups. The overall incarceration rate was 13.45%. The risk of incarceration was age dependent. It ranged from 0.52 daily risk of incarceration, among neonates, to zero daily risk of incarceration among older children. Longer wait times were associated with increased rate and risk of inguinal hernia incarceration.&#x0D; Conclusion: The overall rate of incarceration was high (13.45%). Longer wait times, infants and younger children, male sex, right sided hernias were associated with unacceptably higher rates &amp; risks. Neonates had as much as 5 times higher risk of incarceration than other children. The best time to operate is before 3 weeks for neonates, before 2 months for infants &amp; before 4 months for younger children to prevent incarceration.&#x0D;

Risk of Incarceration of Inguinal Hernias among Paediatric Patients awaiting elective surgery at the University Teaching Hospital, Lusaka, Zambia

Background: This study was conducted to determine our own institutional rate and risk of inguinal hernia incarceration among infants and children awaiting elective surgery. Inguinal hernias in infants and children are very common. One of their common complications before surgery is incarceration. Rate and risk of incarceration among our patients awaiting surgical care was not known.&#x0D; Method: A retrospective review of infants and children under the age of 17 years, who had undergone inguinal hernia repair or had incarcerated, from January 2015 to January 2017 was performed. Interviewer completed questionnaires were used to abstract data from the clinical records. Atotal of 364 patients were included for analysis, in this study. Descriptive statistics, Regression Analysis and Kaplan Meiers Survival Analysis were employed.&#x0D; Results: The infants and children were stratified into seven age groups. The overall incarceration rate was 13.45%. The risk of incarceration was age dependent. It ranged from 0.52 daily risk of incarceration, among neonates, to zero daily risk of incarceration among older children. Longer wait times were associated with increased rate and risk of inguinal hernia incarceration.&#x0D; Conclusion: The overall rate of incarceration was high (13.45%). Longer wait times, infants and younger children, male sex, right sided hernias were associated with unacceptably higher rates &amp; risks. Neonates had as much as 5 times higher risk of incarceration than other children. The best time to operate is before 3 weeks for neonates, before 2 months for infants &amp; before 4 months for younger children to prevent incarceration.

Testicular Necrosis Secondary to Incarcerated Inguinal Hernia in Male Infants. Own Observations

One of the possible consequences of incarcerated inguinal hernia in boys is testicular ischemia because of the prolonged compression of spermatic cord structures by the sac contents, resulting in ipsilateral testicular atrophy. This complication is well described in the literature and occurs in 5-34% of patients. The incidence of testicular atrophy secondary to incarcerated hernia is estimated to be 2-3%. Testicular necrosis as the result of hernia incarceration is, however, an extremely rare clinical setting. We present 4 male infants aged 3-10 weeks with inguinal hernia incarceration which led to ipsilateral testicular loss. All the boys had to be operated on because of irreducible incarcerated hernia and in all the cases testicular necrosis was found intraoperatively. The time of incarceration before surgical intervention ranged from 4 to 12 hours (mean 6.75). Our data show that every case of hernia incarceration in a very young male infant requires rapid diagnosis and proper intervention, i.e. surgical treatment, instead of repeated attempts of manual reduction. Ultrasound examination should estimate not only blood flow through the incarcerated intestinal loop, but also through the ipsilateral testis. Moreover, during the operation of the incarcerated hernia in a boy it is necessary to estimate the ipsilateral testis.

Risk of Incarceration of Inguinal Hernias among Paediatric Patients awaiting elective surgery at the University Teaching Hospital, Lusaka, Zambia

Background: This study was conducted to determine our own institutional rate and risk of inguinal hernia incarceration among infants and children awaiting elective surgery. Inguinal hernias in infants and children are very common. One of their common complications before surgery is incarceration. Rate and risk of incarceration among our patients awaiting surgical care was not known. Method: A retrospective review of infants and children under the age of 17 years, who had undergone inguinal hernia repair or had incarcerated, from January 2015 to January 2017 was performed. Interviewer completed questionnaires were used to abstract data from the clinical records. Atotal of 364 patients were included for analysis, in this study. Descriptive statistics, Regression Analysis and Kaplan Meiers Survival Analysis were employed. Results: The infants and children were stratified into seven age groups. The overall incarceration rate was 13.45%. The risk of incarceration was age dependent. It ranged from 0.52 daily risk of incarceration, among neonates, to zero daily risk of incarceration among older children. Longer wait times were associated with increased rate and risk of inguinal hernia incarceration. Conclusion: The overall rate of incarceration was high (13.45%). Longer wait times, infants and younger children, male sex, right sided hernias were associated with unacceptably higher rates & risks. Neonates had as much as 5 times higher risk of incarceration than other children. The best time to operate is before 3 weeks for neonates, before 2 months for infants & before 4 months for younger children to prevent incarceration.

A Case of Inguinal Hernia Incarceration Associated with Cryptorchidism in an Adult

A Case of Inguinal Hernia Incarceration Associated with Cryptorchidism in an Adult

Scrotal enteric fistula in an extremely low birth weight premature neonate

Abstract Congenital inguinal hernia is a common condition in the pediatric population. Incarceration of inguinal hernias is known to result in significant morbidity such as necrotic bowel, and if not recognized promptly, has the potential to present as a scrotal fecal fistula. We present an extremely low birth weight premature male infant who developed spontaneous fecal drainage from his right scrotum.