Inguinal Hernia Sac Research Articles

Does inguinal hernia with ovary and/or fallopian tube in female children after herniotomy affect secondary sexual characteristics and/or fertility? A long-term retrospective study.

The risk of injury to the ovary and/or fallopian tube during herniotomy is notably high when these structures are involved in the hernial contents of female children. This study evaluates the impact of herniotomy involving the ovary and fallopian tube on secondary sexual characteristics and fertility. The medical records for all female children with inguinal hernia who underwent surgery from January 2000 to December 2010 were reviewed retrospectively (n = 1623). A total of 20 female children aged between 2 years and 12 years (mean 5.5years) were diagnosed with ovary and/or fallopian tube contents within their inguinal hernia sacs. Preoperative B-ultrasound confirmed these findings in all 20 patients. Intraoperatively, 14 hernia sacs contained both ovaries and fallopian tubes and 6 contained only ovaries. There were 12 cases on the right side, 7 cases on the left side and 1 case on both sides. All underwent successful hernia reduction and sac repair without any recurrences. Follow-up periods ranged from 12 to 20 years, averaging 15.5 years. During follow-up, 13 patients had normal pregnancy, 7 patients had normal secondary sexual characteristics. Preoperative B-ultrasonography and careful discerning of the hernia contents during herniotomy may help avoid incision or excision of the ovary and/or fallopian tube.

Amyand’s Hernia: A Case Report

Amyand's hernia is defined as the presence of the appendix vermiformis (inflamed or non-inflamed) within the inguinal hernia sac. It is seen in approximately 1% of inguinal hernia cases. This extremely rare condition is often diagnosed conventionally, at surgery. However, with the increasing use of computed tomography (CT) and ultrasonography (US) examinations, preoperative diagnosis is also possible. The treatment approach varies depending on whether the appendix inside the hernia sac is inflamed or not. For this reason, imaging examinations are of great importance in making a diagnosis and directing treatment. As a result of imaging examinations in an elderly patient in our clinic, colon, small intestine segments, omentum and appendix were detected in the right inguinal canal. Since the appendix was also located within the hernia sac, the case was called Amyand's hernia. In this article, we wanted to draw attention to Amyand's hernia in general and the place of radiological examination in diagnosis and treatment of this disease.

Amyand's hernia concurrent with appendicitis: A literature review

When the vermiform appendix is inside the hernia sac, an uncommon kind of inguinal hernia known as Amyand's hernia (AH) occurs. Typically, an unintentional discovery discovered during surgery serves as the basis for the diagnosis. Only a tiny percentage of patients with inguinal hernias have AH, and even fewer experience problems with acute ischemia. The referral to general surgical services was due to an inguinal tumor located in the right lower quadrant of our 65-year-old male patient. There may be consequences from ischemia because this was not touch-sensitive. The appendix was removed by open hernioplasty. Treatment for type 1 AH, which this patient has, consists of mesh repair and hernial reduction. Despite not having acute appendicitis, our patient needed an appendectomy due to anatomical variation in their AH, which raised the possibility of hernial incarceration. Because of its size and adhesions inside the hernia, this treatment was also thought to be essential for preventing the recurrence of the hernia. This paper introduces a new method for handling the accidental finding of a type 1 AH. There are few treatment suggestions available for anatomic variations of the AH. The physical characteristics of AH may be included to overcome the drawbacks of the traditional Losanoff and Basson's AH classification methods for AH management and categorization. By using this method. Amyand's hernia occurs when a vermiform appendix is discovered inside an inguinal hernia sac. The objectives of this comprehensive investigation were to gather information on its occurrence, clinical picture, diagnosis, and treatment course.

A comparative study of smooth muscle cell characteristics and myofibroblasts in processus vaginalis of pediatric inguinal hernia, hydrocele and undescended testis

BackgroundCongenital inguinal hernia, hydrocele and undescended testis (UDT) are associated with patent processus vaginalis. The smooth muscles present in the processus vaginalis aid in the descent of the testis and undergo programmed cell death after testicular descent leading to obliteration. The persisting amount of smooth muscle in the processus vaginalis influences the clinical outcome as inguinal hernia, hydrocele or UDT. Therefore, a study was conducted to evaluate the processus vaginalis in these three conditions to observe the presence and phenotype of smooth muscle cells and the presence of myofibroblasts.Materials and methodsThe processus vaginalis sacs in patients with inguinal hernia, hydrocele and UDT were examined using light microscopy for the presence and distribution of smooth muscle cells and immunohistochemical staining for vimentin, desmin, and α-smooth muscle actin (SMA) to identify the smooth muscle phenotype. Transmission electron microscopy was also performed in all the sacs to observe the presence of myofibroblasts.ResultsSeventy-eight specimens of processus vaginalis (from seventy-four patients), distributed as 47%, 27%, and 26% as inguinal hernia, hydrocele and UDT respectively, were included in the study. The sacs from inguinal hernia and hydrocele had significantly more presence of smooth muscles distributed as multiple smooth muscle bundles (p < 0.001). Desmin and SMA staining of smooth muscle cells was observed in significantly more sacs from hydrocele, followed by inguinal hernia and UDT (p < 0.001). The sacs from UDT had a significant presence of striated muscles (p = 0.028). The sacs from inguinal hernia had a significant presence of myofibroblasts, followed by hydrocele and UDT (p < 0.001) and this significantly correlated with the light microscopy and immunohistochemical features. The processus vaginalis sacs from four female patients did not differ statistically from the male inguinal hernia sacs in any of the above parameters.ConclusionThe processus vaginalis sacs in pediatric inguinal hernia, hydrocele and undescended testis differ in the presence, distribution and phenotype of smooth muscles and the presence of myofibroblasts. The clinical presentations in these entities reflect these differences.

Incomplete bowel obstruction caused by sigmoid colon cancer in an inguinal hernia: a case report

BackgroundMost colon cancers that develop in the intestinal tract within the inguinal hernia sac are identified by incarceration. However, treatment methods for these cases vary depending on the pathology. Cases showing perforation or abscess formation require emergency surgery for infection control, while cases with no infection generally involve oncological resection, with laparoscopic surgery also being an option. We encountered a case of Incomplete bowel obstruction secondary to sigmoid colon cancer within the hernial sac. We report the process leading to the selection of the treatment method and the surgical technique, along with a review of the literature.Case presentationA 79-year-old man presented to our hospital complaining of a left inguinal bulge (hernia) and pain in the same area. The patient had the hernia for more than 20 years. Using computed tomography, we diagnosed an incomplete bowel obstruction caused by a tumor of the intestinal tract within the hernial sac. Since imaging examination showed no signs of strangulation or perforation, we decided to perform elective surgery after a definitive diagnosis. After colonoscopy, we diagnosed sigmoid colon cancer with extra-serosal invasion; however, we could not insert a colorectal tube. Although we proposed sigmoid resection and temporary ileostomy, we chose the open Hartmann procedure because the patient wanted a single surgery. For the hernia, we simultaneously used the Iliopubic Tract Repair method, which does not require a mesh. Eight months after the surgery, no recurrence of cancer or hernia was observed.ConclusionsWe report a case of advanced sigmoid colon cancer with a long-standing inguinal hernia that later became incomplete bowel obstruction. Although previous studies have used various approaches among the available surgical methods for cancer within the hernial sac, such as inguinal incision, laparotomy, and laparoscopic surgery, most hernias are repaired during the initial surgery using a non-mesh method. For patients with inguinal hernias that have become difficult to treat, the complications of malignancy should be taken into consideration and the treatment option should be chosen according to the pathophysiology.

Inguinal hernia containing pyometra, jejunum and ileum in a dog

AbstractAn 8‐year‐old, intact, female, mixed breed dog was presented due to vomiting, constipation and inguinal swelling. Haematology and biochemistry revealed leukocytosis. A lateral abdominal radiograph revealed a soft tissue opacity, round to ovoid mass, in the caudal inguinal region. Gas‐filled intestinal loops were present at the cranial aspect of the mass. Further imaging was declined. Thus, an exploratory laparotomy was performed. An inguinal hernial sac containing fluid, a closed pyometra and intestinal loops was revealed. The contents of the inguinal hernia were returned to the abdominal cavity, an ovariohysterectomy was performed via a median laparotomy and the inguinal ring was closed, leaving the caudal aspect open. The dog's recovery was uneventful. To the authors’ knowledge, this is the first reported case of pyometra inguinal herniation in a dog with concurrent herniation of the jejunum and ileum.

Amyand&amp;apos;s hernia unveiled: a case report on perforated appendix within the inguinal hernia sac

Background: Acute appendicitis (AA) is still a common cause of lower abdominal pain, which frequently leads to emergency room (ER) visits. A case of perforated appendix within the inguinal hernia sac was presented. Case presentation: The clinical journey of a 30-year-old male patient with acute right iliac fossa pain suggestive of recurrent appendicitis was detailed in this case report. The patient\&amp;apos;s complicated medical history, which included dostinex-treated hyperprolactinemia and a previous episode of conservatively managed appendicitis in 2017, sets the stage for complex diagnostic challenges. The patient complained of acute localized tenderness and pain in the right iliac fossa, but no gastrointestinal symptoms, fever, or diarrhea were present. The admission laboratory results showed elevated white blood cells (WBC) (15.2), hemoglobin (Hb) (15.8), and platelet (PLT) (191) levels. Computed tomography scans exposed a perforated appendix within the right inguinal hernial sac surrounded by inflammatory changes. Laparoscopic appendectomy revealed a perforated appendix within the inguinal hernial sac, necessitating omental dissection and drainage. The postoperative course was uneventful, with a 7-day hospital stay and subsequent OPD follow-up. Microscopic examination confirmed acute suppurative appendicitis with periappendicitis aligning with clinical and radiological assessments. Conclusions: Amyand\&amp;apos;s hernia is a rare type of hernia that involves the appendix. A perforated appendix within a groin hernia is unusual and necessitates immediate source control to manage infection and prevent sepsis.

A clinical case of successful treatment of acute phlegmonous appendicitis incarcerated in a hernial sac (Amyand’s hernia)

Atypical localization of the vermiform appendix (VA) in acute appendicitis can lead to diagnostic and tactical errors in emergency abdominal surgery. The rarest and most atypical localization of the VA is within the hernial sac. This type of hernia is defined as Amyand’s hernia. The optimal scope of surgical intervention and access method (laparoscopic or open) for Amyand’s hernia have not been definitively determined. Questions remain regarding the necessity of removing an unaffected vermiform appendix, the approach to hernioplasty in destructive appendicitis, and the feasibility of using a mesh implant for hernioplasty. In cases of a sliding hernia, the destruction of the hernial sac can lead to difficulties with suturing the peritoneum, assessing the state of the strangulated testicle in men, and performing an orchidectomy. Therefore, it is imperative to establish an algorithm for the evaluation and surgical management of patients with strangulated inguinal hernias. Objective — present a clinical case of successful treatment of Amyand’s hernia with acute phlegmonous appendicitis incarcerated in a strangulated inguinal hernial sac and reactive orchoepididymitis, focusing on the selection of medical and diagnostic strategies to reduce the risk of complications. The clinical case illustrates the effective management of a patient who presented with acute phlegmonous appendicitis and purulent orchoepididymitis. These abnormalities were found to be atypically localised within the sac of a strangulated right‑sided inguinal hernia, known as Amyand’s hernia. The necessary surgical procedures included an appendectomy and an orchidectomy. Conclusions. Inflammation of the vermiform appendix in Amyand’s hernia can lead to various unpredictable purulent complications, such as acute typhlitis, purulent peritonitis, necrotizing orchoepididymitis, and Fournier’s phlegmon, necessitating extensive surgical intervention. The collective global and personal experience in treating Amyand’s hernia suggests the possibility of establishing standardised protocols for diagnosing and selecting a surgical intervention technique.

A Simple and Effective Technique for Torn Hernial Sac Occurred During Large Inguinal Hernia Repair or Orchiopexy: Incision

Tearing of hernial sac during giant inguinal hernia repair or orchiopexy presents a challenge to the pediatric surgeons, even in expert hands. We here describe a technique that is easy for performing high ligation in cases complicated with torn hernial sac. The steps of our incision technique is: Non-separated part was tightened with the help of forceps localized at the lateral aspects of teared sac. The incision to the sac was fashioned by scalpel No 15, while taking care to avoid injury to the underlying testicular vessels and vas deferens. Then, wound edges of the proximal hernia sac were moved forward by using fine tissue forceps and scalpel. The walls of proximal sac were totally grasped in one forceps and dissected gently from the remaining adhesions and cremasteric fibers up to the level of the internal ring. The mean age of the patients was 13.9±18.1 months (range 3 weeks-7 years). The diagnosis of the patients was inguinal hernia in 17 (63%) and undescended testis in 10 (37%). Seven (25,9%) of the patients had a large inguinal hernia sac. There were no intraoperative and postoperative complications. This is a safe and effective technique in patients complicated with torn hernial sac during herniotomy. It reduces the risk of further tearing of hernial sac. Short duration is another advantage. This technique can also be performed with using surgical loupe or microscope to care not to damage the vas and vessels.

Amyands hernia in pediatric case: Manageable but challenging to diagnose preoperatively

Vermiform appendix within inguinal hernial sac is known as amyands hernia which is rare entity. Incidence varies from 0.5% to 1%. Vermiform appendix may or may not present as appendicitis however the trapped appendix may incarcerate and may present with perforation and strangulated.Here we report a case of 2 year old baby presented as right sided inguinoscrotal, reducible, painless swelling since birth. He was diagnosed as inguinal hernia. During herniotomy appendix was found as its content.This case report aims to document another case of amyands hernia impersonating as inguinal hernia as patients often are asymptomatic with low level of suspicion even on routine ultrasonography hence surgeon may encounter unexpected intraoperative findings.

A rare case of perineal neuralgia treated with ultrasound‐guided nerve block combined with water separation

AbstractA middle‐aged man experienced intermittent acupuncture‐like pain in the skin of the right scrotum and medial thigh 1 month after undergoing laparoscopic high ligation of the right hernial sac for a right indirect inguinal hernia in November 2020, and the pain persisted for 6 months. Under ultrasound guidance, ilioinguinal and genitofemoral nerve block and local adhesion water separation were performed with a mixture of 0.25% lidocaine (6 mL) plus prednisolone acetate (10 mg), and the same drugs and methods were repeated five times once a week. After five treatments, the visual analogue scale (VAS) score was reduced from 7 before treatment to 1. During the follow‐up period, at 3 months after the end of treatment, the VAS score remained at 0, and this score was sustained at 0 even at the 6‐month follow‐up. These outcomes indicate that ultrasound‐guided nerve block combined with water separation technology can effectively alleviate neuralgia caused by surgical adhesion, which holds important clinical significance in managing such conditions.

Amyand’s hernia-an unusual presentation of mucocele of appendix within inguinal hernia

Presence of an appendix within an inguinal hernial sac is a rare form of inguinal hernia with an appendix involved and may become incarcerated. The incidence of a normal appendix in hernial sac varies from 0.5% to 1%. Only in 0.13% of the cases, appendicitis was reported. We present a rare variant of Amyand’s hernia containing mucocele of the appendix, which has not yet been reported in literature. An appendectomy was done under spinal anaesthesia. An Onlay mesh repair was performed. Patient made an uneventful recovery.

Inflammed appendix as a cause of incarcerated inguinal hernia in a neonate

Inflamed appendix as a cause of incarcerated inguinal hernia is a rare presentation in any age group. Appendix as a content in an inguinal hernial sac was named after the French surgeon Claudius Amyand (c.1681-1740), who performed the first successful appendectomy, on an 11-year-old boy who presented with an inflamed, perforated appendix in his inguinal hernia sac. Treatment of this condition is herniotomy with its repair with or without appendectomy depending on its involvement (inflammation status). We are reporting the case, in which, the inflamed appendix was presented as incarcerated inguinal hernia. The management of Amyand’s hernia depends on the variability of involvement of the appendix however, in children and neonates, it is better to perform appendectomy during the hernia repair.

Bilateral Obstructed Inguinal Hernia with Left Amyand’S Hernia: A Rare Case Report

Obstruction and strangulation are the most vicious complications of inguinal hernia that require prompt intervention in the form of surgical exploration. Presence of appendix in the inguinal hernia sac is a rare condition seen in less than 1% of all inguinal hernia cases. Usually this appendix is on right side, but its presence on the left side is extremely rare.&#x0D; Case Report: A 70 year male patient with scrotal swelling and inability to pass stool and flatus presented to JNMCH emergency. Upon examination and evaluation a diagnosis of intestinal obstruction secondary of obstructed inguinal hernia was made. Further, upon exploration, a healthy appendix and caecum was seen in left sac whereas right sac contained small bowel, which was unhealthy.

Histopathological Findings in Hernia Sacs: A Clinical and Pathological Review.

Routine histopathological examination of hernia sac in adults remains a controversial topic. We undertook a retrospective study to assess possible clinical benefits of pathological examination of hernia sac specimens. Our pathology database between 1992 and 2020 was searched for adult specimens submitted as hernia sac. The clinical and pathological data of patients with abnormal histopathological findings were reviewed. There were 5424 hernia sac specimens (3722 inguinal, 1625 umbilical, and 77 femoral), 32/5424 (0.59%) with malignancies (28 epithelial and 4 lymphoid) and 25/32 were located in the umbilical region. Twelve out of twenty-five malignancies (48%) presented as primary clinical manifestations of the diseases (5 GI tract carcinomas, 5 gynecological tract carcinomas, and 2 lymphoid neoplasms); and 13/25 (52%) specimens were involved by previously known tumors (8 gynecological carcinomas, 3 colon carcinomas, 1 breast carcinoma, and 1 lymphoma). Among the 7 inguinal hernia sacs with malignancies, 3 (42.9%) were primary presentations of the tumors (2 prostatic carcinomas, 1 pancreatic carcinoma), and 4 (57.1%) were previously known tumors (2 ovarian carcinomas, 1 colon carcinoma, 1 lymphoid). Benign lesions were 12/5424 (0.22%), including 7 adrenal rests, 4 endometriosis, and 1 inguinal sarcoidosis. The incidence of hernia sacs with malignancies was 32/5424 (0.59%), most commonly from nearby organs in gynecological tract. However distant metastases from breast were also present. Near half of the hernia sac with malignancies (15/32, 47%) presented as the first clinical manifestation. Routine histopathological examination of hernia sac in adults is recommended, since it may provide important clinical information.

Sac invagination versus sac ligation in open Lichtenstein repair of indirect inguinal hernia: A systematic review and meta-analysis of randomized controlled trials

BackgroundTo compare the outcomes of sac invagination and sac ligation in patients undergoing open Lichtenstein repair of indirect inguinal hernia. MethodsA systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards was conducted to identify all randomized controlled trials comparing the outcomes of sac invagination and sac ligation in patients undergoing open Lichtenstein repair of indirect inguinal hernia. Random effects modeling was applied to calculate pooled outcome data. ResultsAnalysis of 843 patients with 851 hernias from 6 randomized controlled trials suggested no difference between the sac invagination and sac ligation techniques in terms of recurrence (risk difference: 0.00, P = .91), chronic pain (risk difference: 0.00, P = .98), operative time (mean difference: –0.15, P = .89), hematoma (odds ratio: 0.93, P = .93), seroma (odds ratio: 1.00, P = 1.00), surgical site infection (odds ratio: 1.68, P = .40), or urinary retention (odds ratio: 0.85, P = .78); however, ligation of sac resulted in more early postoperative pain as measured by visual analog scale score at 6 hours postoperatively (mean difference: –0.92, P < .00001), at 12 hours postoperatively (mean difference: –0.94, P = .001), at 24 hours postoperatively (mean difference: –1.08, P < .00001), and on day 7 postoperatively (mean difference: –0.99, P = .009). The quality and certainty of the available evidence were moderate. ConclusionEvidence from randomized controlled trials with moderate certainty suggests that ligation of indirect inguinal hernia sac during open Lichtenstein repair may not improve the outcomes regarding recurrence, chronic pain, or operative complications but may result in more early postoperative pain. Future randomized controlled trials with more robust statistical power and methodological quality would help improve the available evidence's certainty.

Distal Shunt Migration; A Case Series

Ventriculoperitoneal shunts are one of the commonest surgical procedures performed in neurosurgery and the most commonly used method to treat hydrocephalus worldwide. The mechanical complication of shunt migration is a rare event roughly noted in 1 in 1000 patients who have undergone a shunt procedure. Ventriculo-peritoneal shunt migration to mouth, thorax, transdiaphragmatic, heart, pulmonary artery, breast, stomach, gallbladder, liver, small bowel, umbilicus, colon, inguinal hernia sac, bladder, vagina, anus, and scrotum have been reported in the literature.

Amyand's Hernia: Appendix in Hernia or Hernial Appendicitis?

The presence of an appendix in the inguinal hernia sac is defined as Amyand's hernia (AH). This study intends to present the authors' experience in dealing with this entity and also to present a discussion on possible need of updating its definition, classification, and management. A retrospective analysis of records of all pediatric patients undergoing surgery for congenital inguinal hernia in a single unit from January 2017 to March 2021 was done. Patient's demographics, clinical presentation, preoperative investigations, peroperative findings, and postoperative outcomes were recorded and analyzed. AH was found in eight patients. All were boys. The median age of presentation was 20.5 months (range 2 months to 36 months). The mean duration of symptoms was 2 days (range 2 to 4 days). All patients presented with incarcerated inguinoscrotal swelling (right sided = 5, left sided = 3); associated with pain. An abdominal radiograph and ultrasonography were done for all. All patients underwent emergency surgery. Exploration was done for all through an inguinal incision. The appendix was found inflamed for two patients, and appendectomy was done for the same. None of the patients underwent incidental appendectomy. Wound infection, secondary appendicitis, and recurrence were not seen for any of the patients. The authors have also proposed a revised definition and classification of AH. AH is an interesting entity and many questions like the need for incidental appendectomy remain unanswered. An updating of the definition and classification system can probably offer some solution in this regard. However, more research is warranted in this regard.

Perforated Sigmoid Diverticulitis Within a Strangulated Inguinal Hernia.

We present a rare case of perforated diverticulitis within an inguinal hernia sac adjacent to a synthetic mesh from a prior incisional hernia. An 80-year-old-female presented to the ED with abdominal pain. Cross-sectional imaging was significant for a small bowel obstruction with a transition point in the right lower quadrant (RLQ). On physical exam, the patient had palpable bilateral inguinal hernias that were reducible; however, after 48hours of nonoperative management she failed to progress. Repeat imaging was concerning for incarcerated bowel within the inguinal hernia sac. She was taken to the operating room for exploratory laparotomy where the right inguinal hernia sac was found to contain sigmoid colon with diverticular perforation. A small bowel resection, right hemicolectomy and Hartmann's procedure were performed. The previously placed synthetic mesh was not contaminated during this operation and was not removed. Her hospital course was otherwise unremarkable but prolonged by the patient's deconditioned state.

Management of Perforated Sigmoid Colon Cancer in an Incarcerated Inguinal Hernia Using a Combined Abdominal and Inguinal Approach.

The ideal management of perforated colorectal cancer in the hernia sac remains a challenge for general surgeons. We report such a case requiring a combined-incision surgical approach and two-stage operation. A male patient in his 80s presented with fatigue and a bulge in his left groin. Contrast-enhanced CT scan revealed a sigmoid colon perforation within the left inguinal hernia sac. A combination of midline abdominal and inguinal incisions was performed for the iliopubic tract repair and Hartmann procedure. Six months later, the recurrent inguinal hernia was repaired using the Kugel mesh. The treatment strategy for colonic perforation into the inguinal hernia remains nonstandardized, compared to those for nonperforated cases. Combined inguinal and midline abdominal incisions might be necessary for infected lesion removal and colon mesentery resection; using mesh to repair hernia is a rare option. Hernia repair using mesh can be performed in two stages when recurrence occurs.