Incarceration Of Hernia Research Articles

Incidence of Incarceration of Inguinal Hernia in Adults.

Incidence of Incarceration of Inguinal Hernia in Adults.

Small bowel obstruction caused by rare intraluminal hematoma secondary to gastric bypass: a case report

Abstract Introduction: With the increase in obesity and therefore obesity surgery in the world, there is also an increase in surgery-related complications. Mechanical small bowel obstruction after gastric bypass is a common complication and the most common causes of obstruction are kinking or stenosis of the entero-enterostomy, internal herniation, adhesions, external compression on the transverse mesocolon, incarceration of an abdominal wall hernia, or intussusception. One of these complications is intraluminal hematoma, which, although rare, has dangerous consequences that can even lead to mortality. Since it is a life-threatening complication, early diagnosis and emergency intervention are important. Case report: In this case report, we wanted to emphasize the early effectiveness of radiology and surgery in the diagnosis and treatment processes of a patient with intraluminal hematoma after laparoscopic roux-NY gastric bypass. Conclusion: . The most common location of intraluminal hematoma is the jejunojejunal anastomosis area. Symptoms may occur earlier (at the 12th postoperative hour). Whole-abdominal MDCT remains the main method of diagnosing intestinal obstruction, including small bowel obstruction resulting from intraluminal hematoma.

Surgical Challenges During the COVID-19 Crisis: A Comparative Study of Inguinal Hernia Treatment in Romania.

Background and Objectives: The COVID-19 pandemic disrupted healthcare systems worldwide, leading to the postponement of elective surgeries, including inguinal hernia repair (IHR), as healthcare resources prioritized critical care. This study aims to evaluate the impact of the pandemic on the incidence and outcomes of IHR procedures. Materials and Methods: A retrospective review was conducted on 604 patients who underwent IHR over six years, spanning pre-pandemic, pandemic, and post-pandemic periods. Data on patient demographics, type of surgical procedure (elective or emergency), use of mesh, surgical duration, hospitalization period, and postoperative outcomes were analyzed across the three time frames. Results: Patient age remained consistent across the three periods, but a significant increase in female patients was observed during and after the pandemic (p < 0.001). Elective IHR surgeries significantly decreased during the pandemic (p < 0.001), paralleled by an increase in emergency cases (p = 0.004). In the post-pandemic period, elective surgeries rebounded, while emergency interventions declined (21.9% vs. 10.3%). Mesh repair usage increased notably in the post-pandemic phase (p < 0.001). Although surgeries took longer during the pandemic (p < 0.001), both total and postoperative hospital stays were reduced during and after the pandemic (p < 0.001). Minimal postoperative complications were reported throughout, with only one mortality during the pandemic. Conclusions: This study highlights the need for robust healthcare strategies to maintain elective surgical care during global crises, as delays in IHR may elevate risks for complications like hernia incarceration and strangulation.

Incarcerated Intestine by Testicular Mass in Huge Scrotum: A Case Report

Large testicular tumor is not a commonly seen entity in the modern era. While treatment of large testicular tumors is via inguinal radical orchiectomy, large testicular tumors carry the dilemma of delivering these large masses via the inguinal or scrotal approach. Our case was a 90 years old man with obstruction signs and huge scrotum that shows incarcerated large bowel with huge testicular mass, that in his surgery we did Radical Orchiectomy and we replace incarcerated Large Bowel in scrotum and discharge him successfully. Giant testicular cancer is considered one of the largest testicular masses in the world. Delayed seeking medical advice and appropriate management is the major cause behind this rare presentation. Increasing the awareness regarding self-examination and eliminating the stigma is the cornerstone to markedly reduce this type of unusual presentation since any testicular size change and mass can be easily noted by the patient. Surgical exploration and adjuvant chemotherapy seems as a reasonable treatment option in the setting of bilateral intra-abdominal testis tumor in an adult patient. The study underscores the effectiveness of the intervention in promoting preventive behaviours against testicular cancer among university students, laying the groundwork for future educational initiatives. Although testicular cancer (TC) is the most common malignancy in males between the ages of 18 and 50 years, little effort has been made to increase public awareness about TC and testicular self-examinations (TSEs). Intestinal obstruction without a past surgical history of abdominal surgeries or trauma is a rare and challenging clinical situation. This case report describes the presentation, diagnosis, and management of intestinal obstruction in a patient with an uncommon aetiology of small bowel obstruction. Chronic hernia incarceration can lead to weakening and ischemia of the bowel, and minimal trauma can lead to perforation of the weakened segment. In such presentations, bowel resection and repair of the defect with a biological material is safe and feasible.

EMERGENCY LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) HERNIOPLASTY FOR GARANGEOT'S HERNIA: A CASE REPORT

Abstract Aims This video presentation aims to demonstrate the successful management of a rare and challenging case of Garangeot's hernia through Emergency Laparoscopic Transabdominal Preperitoneal (TAPP) Hernioplasty. The primary objectives include highlighting the surgical technique, intraoperative findings, and postoperative outcomes in the context of this uncommon hernia presentation. Materials and Methods An 84-year-old female presented to the emergency department with signs of femoral hernia incarceration. Upon exploration, a Garangeot's hernia, characterized by the presence of the appendix within a femoral hernia sac, was identified. In light of the emergency and the patient's deteriorating condition, an Emergency Laparoscopic TAPP Hernioplasty was performed. The procedure involved meticulous dissection of the hernia sac, reduction of the herniated appendix and appendectomy, and subsequent mesh reinforcement of the femoral defect. Results The video illustrates the step-by-step approach to Emergency Laparoscopic TAPP Hernioplasty in the context of Garangeot's hernia. Intraoperative findings, including the condition of the herniated appendix and associated anatomical structures, are presented. Postoperative outcomes, including recovery, complications, and follow-up observations, are discussed to provide a comprehensive understanding of the case. Conclusions Emergency Laparoscopic TAPP Hernioplasty emerges as a viable and effective intervention for Garangeot's hernia, offering advantages such as reduced morbidity, quicker recovery, and minimal surgical trauma. This video contributes valuable insights into the management of this rare hernia presentation, emphasizing the role of minimally invasive techniques in achieving successful outcomes.

Association of socioeconomic vulnerability with clinical and financial outcomes following emergent hernia repair

BackgroundWhile race and insurance have been linked with greater likelihood of hernia incarceration and emergent presentation, the association of broader social determinants of health (SDOH) with outcomes following urgent repair remains to be elucidated. Study designAll adult hospitalizations entailing emergent repair for strangulated inguinal, femoral, and ventral hernias were identified in the 2016–2020 Nationwide Readmissions Database. Socioeconomic vulnerability was ascertained using relevant diagnosis codes. Multivariable models were developed to consider the independent associations between socioeconomic vulnerability and study outcomes. ResultsOf ∼236,215 patients, 20,306 (8.6 ​%) were Vulnerable. Following risk-adjustment, socioeconomic vulnerability remained associated with greater odds of in-hospital mortality, any perioperative complication, increased hospitalization expenditures and higher risk of non-elective readmission. ConclusionsAmong patients undergoing emergent hernia repair, socioeconomic vulnerability was linked with greater morbidity, expenditures, and readmission. As part of patient-centered care, novel screening, postoperative management, and SDOH-informed discharge planning programs are needed to mitigate disparities in outcomes.

Immediate Versus Delayed Surgical Management of Infant Cryptorchidism With Inguinal Hernia

IntroductionCryptorchidism is commonly treated with orchiopexy at 6–12 months of age, often allowing time for undescended testicle(s) (UT) to descend spontaneously. However, when an inguinal hernia (IH) is also present, some surgeons perform orchiopexy and inguinal hernia repair (IHR) immediately rather than delaying surgery. We hypothesize that early surgical intervention provides no benefit for newborns with both IH and UT. MethodsThe Nationwide Readmissions Database was used to identify newborns with diagnoses of both IH and UT from 2010 to 2014. Patients were stratified by management: IHR performed on initial admission (Repair) or not (Deferral). Demographics, outcomes, and complications were compared. Results were weighted for national estimates. ResultsWe analyzed 1306 newborns (64% premature) diagnosed with both IH and UT. IHR was performed at index admission in 30%. Repair was more common in premature babies (43% vs. 8% full-term, p < 0.001) and patients with congenital anomalies (33% vs. 27% without congenital anomaly, p = 0.012). There was no difference in readmission rates. Repair patients had higher rates of orchiectomy than did Deferral. No Deferral patients were readmitted for bowel resection, and <1% were readmitted for orchiectomy or hernia incarceration. ConclusionIn newborns with UT and IH, immediate repair is not associated with improved outcomes. Even with incarceration on initial presentation, rates of readmission with incarceration or bowel compromise for patients who undergo Deferral of surgery are minimal. Moreover, Repair newborns have higher rates of orchiectomy. We found no benefit to early operative intervention; thus, we recommend waiting until 6–12 months of age to reassess for surgery. Level of EvidenceLevel III Type of StudyRetrospective Comparative Study.

Being Caught in a Vicious Circle: An Interview Study of Individuals Suffering From Grade II-IV Hiatal Hernia.

Large paraesophageal hernias are related to life-threatening complications that warrant immediate surgery. Whether the long-standing chronic symptoms related to the disease in individuals without hernia incarceration motivate surgical treatment is still a subject for discussion. The aim of this study was to explore how individuals suffering from Grade II-IV hiatal hernia describe their symptoms and health, as well as how the disease affects their life. Semistructured interviews were performed with 22 individuals planning to undergo surgery for a large paraesophageal hernia. The data were analyzed using qualitative content analysis and resulted in one main theme "Being caught in a vicious circle" and six subthemes "Distressing and uncertain times," "The symptoms have seized control over my health," "Loss of energy and strength," "Strategies for managing daily life," "Loss of social life," and "Moments of hope despite failing health." Central to the participants' descriptions is their commitment to strategies for managing the ever-present and unpredictable symptoms that have seized control over their health. They were trapped in a hopeless and isolated existence, that is, a vicious circle, from which they were unable to escape. Despite the low incidence of volvulus and incarceration, the symptom burden and effect on general health motivate treatment in these individuals.

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.

Predictors of acute incisional hernia incarceration at initial hernia diagnosis on computed tomography.

Acute incisional hernia incarceration is associated with high morbidity and mortality yet there is little evidence to guide which patients will benefit most from prophylactic repair. We explored baseline computed tomography (CT) characteristics associated with incarceration. A case-control study design was utilized to explore adults (≥18 years) diagnosed with an incisional hernia between 2010 and 2017 at a single institution with a 1-year minimum follow-up. Computed tomography imaging at the time of initial hernia diagnosis was examined. Following propensity score matching for baseline characteristics, multivariable logistic regression was performed to identify independent predictors associated with acute incarceration. A total of 532 patients (27.26% male, mean 61.55 years) were examined, of whom 238 experienced an acute incarceration. Between two well-matched cohorts with and without incarceration, the presence of small bowel in the hernia sac (odds ratio [OR], 7.50; 95% confidence interval [CI], 3.35-16.38), increasing sac height (OR, 1.34; 95% CI, 1.10-1.64), more acute hernia angle (OR, 0.98 per degree; 95% CI, 0.97-0.99), decreased fascial defect width (OR, 0.68; 95% CI, 0.58-0.81), and greater outer abdominal fat (OR, 1.28; 95% CI, 1.02-1.60) were associated with acute incarceration. Using threshold analysis, a hernia angle of <91 degrees and a sac height of >3.25 cm were associated with increased incarceration risk. Computed tomography features present at the time of hernia diagnosis provide insight into later acute incarceration risk. Improved understanding of acute incisional hernia incarceration can guide selection for prophylactic repair and thereby may mitigate the excess morbidity associated with incarceration. Prognostic and Epidemiological; Level III.

P-047 REDUCING THE RISK OF MESH EROSION IN A MODIFIED RETROMUSCULAR SUGARBAKER TECHNIQUE FOR PARASTOMAL HERNIA REPAIR

Abstract Aim Modified retromuscular Sugarbaker procedure (SP) is a promising approach for parastomal hernia repair. However, its potential complications, including the risk of mesh erosion, encourages us to develop other techniques of mesh placement. We propose an addition to this parastomal retromuscular mesh reinforcement. Materials and Methods We present the case of a 53 year old-woman, with a history of proctocolectomy with end ileostomy due to anal adenocarcinoma, undergoing emergency surgery due to parastomal hernia incarceration. Sugarbaker repair was performed placing inlay composite mesh fixed with reabsorbable tackers. Subsequently, the patient was admitted for recurrent parastomal hernia and midline ventral hernia surgery. Results We performed a modified retromuscular SP as described by Pauli in 2016. After midline laparotomy, hernia content was reduced and extensive retromuscular dissection with transversus abdominis release (TAR) performed, placing a wide retromuscular polypropylene mesh prior to closing parastomal fascial defect. Stoma was parietalized from lateral to medial in an S-shaped configuration. We placed a segment of bioabsorbable mesh covering the parietalized stoma to avoid direct contact with the polypropylene mesh. No recurrence was detected 3 months after surgery, pending reassessment at 6 months. Conclusions This repair provides the benefits of an open posterior component separation with TAR, maintaining the biomechanics of a functional abdominal wall, whilst offering the advantages of mesh reinforcement in a modified Sugarbaker configuration. Our experience with this novel technique seems promising. Rate of mesh erosion is yet to be defined and requires long-term studies before widespread adoption, with special concern on mesh placement.

Congenital internal hernia in the neonate: Case series with review of potential comorbidities and imaging findings

Internal hernias are a rare but serious complication that typically present in older children and adults and can be congenital or iatrogenic in origin. They are often difficult to diagnose due to their similar radiological and clinical presentation to more common abdominal pathologies. We describe three cases of congenital internal hernias presenting in preterm infants followed by a literature review of congenital internal hernias presenting shortly after birth. When presenting in the neonatal period, congenital internal hernias have been exclusively reported as transmesenteric type. The exact etiology of transmesenteric congenital internal hernias is unclear, but may be a result of vascular compromise to the mesentery creating a small defect in which bowel may become entrapped. Certain genetic factors may also play a role in increasing risk for congenital internal hernias as they can be comorbid with other pathologies. Delayed diagnosis postpones surgical treatment, increasing risk of hernia incarceration, strangulation, irreversible bowel ischemia, and long-term risks inherent to bowel resection. Multimodal imaging plays a key role in the evaluation of these infants by excluding many causes of neonatal intestinal obstruction, however, a definitive prospective radiologic diagnosis has not been reported to date. Radiographic findings and comorbidities associated with these cases can be used along with future reported cases to potentially aid in timely diagnosis.

Treatment of ventral hernias in patients with morbid obesity

The review is devoted to the treatment of ventral hernias in patients with morbid obesity. This issue is important due to significant number of such patients and no unambiguous clinical recommendations. The advantages of simultaneous surgery (with bariatric intervention) are obvious, i.e. lower risk of postoperative hernia incarceration and no need for re-hospitalization with another intervention. High risk of bariatric population makes it necessary to minimize surgery time and surgical trauma. A staged approach with reducing body weight surgically or conservatively before hernia repair is often chosen. Hernia repair should be performed using laparoscopic or robotic techniques with obligatory use of mesh implants. Panniculectomy or abdominoplasty as the main surgery is a valid option. Currently, it is necessary to develop clear criteria for selecting patients with morbid obesity for staged and simultaneous treatment of ventral hernias.

Misdiagnosis of vasitis: a potential diagnostic pitfall with computed tomography

BackgroundVasitis is a rare condition that may be challenging for the clinical practitioner. Sometimes it is misdiagnosed as incarcerated inguinal hernia; thus, patients end up receiving unnecessary surgery. Compared with the traditional approach with only sonography, the more recent introduction of computed tomography in the diagnostic process has provided higher quality imaging and more detailed anatomy. Consequently, some urologists advocate the efficacy of computed tomography in the differential diagnosis of difficult cases.Case presentationWe present the case of a 23-year-old male who suffered from right inguinal pain and swelling. His scrotum ultrasound showed multiple tubular structure dilatation within the subinguinal area and no testis torsion. The initial diagnosis was a right inguinal hernia. Computed tomography supported that initial diagnosis, and we presumed the lesion represented a herniation of the omentum with mesenteric vessels. Since there was a suspicion of hernia incarceration, the patient underwent diagnostic laparoscopy, which did not reveal herniation, but only erythematous reaction and swelling over the right spermatic cord. Following a final diagnosis of vasitis, he received empirical antibiotic treatment and his symptoms entirely resolved.ConclusionsEven though computed tomography can provide thorough imaging of the urogenital system, the contrast enhancement within vessels and inflammatory organs can still be misleading in the diagnostic process.

Modeling Optimal Clinical Thresholds for Elective Abdominal Hernia Repair in Patients With Cirrhosis

Patients with cirrhosis have increased risk of postoperative mortality. Several models have been developed to estimate this risk; however, current risk estimation scores cannot compare surgical risk with the risk of not operating. To identify clinical optimal thresholds to favor operative or nonoperative management for a common cirrhosis surgical scenario, the symptomatic abdominal hernia. This was a Markov cohort decision analytical modeling study evaluating elective surgery vs nonoperative management for a symptomatic abdominal hernia in a patient with cirrhosis. Transition probabilities and utilities were derived from the literature and from data using an established cirrhosis cohort in the Veterans Health Administration. Participants included patients who were referred to a surgery clinic for a symptomatic abdominal hernia. Data were obtained from patients diagnosed with cirrhosis between January 1, 2008 and December 31, 2018. Data were analyzed from January 1 to May 1, 2022. Expected quality-adjusted life-years (QALYs) were estimated for each pathway and iterated over baseline model for end-stage liver disease-sodium (MELD-Na) scores ranging from 6 to 25. Markov models were cycled over a 5-year time horizon. A total 2740 patients with cirrhosis (median [IQR] age, 62 [56-66] years; 2699 [98.5%] men) were referred to a surgery clinic for a symptomatic abdominal hernia; 1752 patients (63.9%) did not receive surgery. The median (IQR) follow-up was 42.1 (25.3-70.0) months. Using this cohort to estimate the mortality risk of operative and nonoperative pathways, an initial MELD-Na threshold of 21.3 points, below which surgery was associated with maximized QALYs was identified. Nonoperative management was associated with increased QALYs above this MELD-Na threshold. Although more patients experienced death with a surgical treatment decision across all initial MELD-Na values, this was counterbalanced by increased time spent in a resolved hernia state associated with increased utility. Model results were sensitive to the probability of hernia recurrence and hernia incarceration and utility decrement in the symptomatic hernia state. This decision analytical model study found that elective surgical treatment for a symptomatic abdominal hernia was favored even in the setting of relatively high MELD-Na scores. Patient symptoms, hernia-specific characteristics, and surgeon and center expertise may potentially impact the optimal strategy, emphasizing the importance of shared decision-making.

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.

EP-25 Double Gastric Outlet Obstruction Caused by an Incarcerated Right Inguinal Hernia, a Rare Presentation

Abstract We report a case of an 84-year old man who presented with double gastric outlet obstruction from an incarcerated right inguinal hernia that contained part of the stomach, most of the small bowel, omentum, appendix, caecum, ascending and transverse colon, causing a double gastric outlet obstruction. Several intra-abdominal organs have been reported in groin hernias including the appendix, bladder, small and large bowel and ovaries. There are approximately 60 cases of inguinal hernias containing the stomach, the majority were before 1980. It's believed that the emphasis of early repair minimized the occurrence of complications and decreased presentations of these cases. Two cases were published in the UK with a similar condition in 2014 of which one was treated conservatively and the other had an open inguinal hernia repair with mesh. He presented to the emergency department with a 1 day history of severe abdominal pain and dark brown vomiting due to incarceration of inguino-scrotal hernia which he had for the last 24 years with no symptoms. His abdomen was soft and non-tender with large right inguino-scrotal hernia which was tender on palpation and irreducible. The diagnosis was confirmed with a CT scan. The P-Possum score was calculated, 2.56% mortality and 49.5% morbidity. He was taken to the theatre, after resuscitation for exploratory laparotomy, omentectomy and inguinal hernia Lichtenstein repair with Vicryl® mesh. At the end, it is thought that long-standing traction on the greater omentum and its attachments may be responsible for the descent of the stomach into the hernia sac.

CHYLE IN HERNIAL SAC IN CHYLOUS ASCITES IN 47 YEARS OLD MALE FROM CHENNAI, INDIA

We present case of a 47 year male, who underwent elective surgical repair for inguinal hernia. During surgery, chyle was unexpectedly found in the hernia sac and abdominal cavity. A thorough diagnostic workup for chylous ascites was performed to rule out pre-existent underlying pathologies, and the patient was temporarily placed on a medium-chain triglyceride diet. No symptoms occurred afterwards. Based on the clinical course and results of additional investigations, this rare phenomenon has most likely occurred due to obstruction and potential rupture of lymphatic structures due to mechanical effects following intermittent incarceration and subsequent repetitive manual reduction of the symptomatic hernia including bowel loops as content of the hernia sac. A search was made and chylous ascites as hernial content was not reported in adults. This is a rare instance.

An Academic Hospitalist–Run Outpatient Paracentesis Clinic

Patients needing large-volume paracenteses (LVPs) can occupy inpatient hospital beds and unnecessarily use inpatient resources.We describe an outpatient paracentesis clinic that was part of a quality assurance initiative at the Veterans Affairs Pittsburgh Healthcare System in Pennsylvania. A retrospective review was conducted that included patient age, sex, etiology of ascites, amount of ascites removed, time of the procedure, complications, and results of ascites cell count and cultures abstracted from the electronic health record.Over 74 months, 506 paracenteses were performed on 82 patients. The mean volume removed was 7.9 L, and the mean time of the procedure was 33.3 minutes. There were 5 episodes of postprocedure hypotension that required admission for 3 patients. One episode of abdominal wall hematoma occurred that required admission. Two patients developed incarceration of an umbilical hernia after the paracentesis; both required surgical repair. Without the clinic, almost all the 506 outpatient LVPs we performed would have resulted in a hospital admission.An outpatient paracentesis clinic run by academic hospitalists can safely and quickly remove large volumes of ascites and minimize hospitalizations.

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．