Inguinal Scrotal Hernia Research Articles

Unveiling the Rarity: A Case Report on Gigantic Primary Scrotal Lipoma

Primary scrotal lipoma is an exceptionally rare finding, typically detected incidentally but posing diagnostic dilemmas when presenting as a substantial mass. Often mistaken initially for inguinal-scrotal hernias or testicular malignancies due to clinical similarities, accurate differentiation is essential for appropriate management. Here, we present a case of a middle-aged male with a massive scrotal swelling, initially raising concerns of malignancy. However, thorough clinical evaluation and imaging studies guided by suspicion for lipomatous origin facilitated the correct diagnosis. Histopathological examination confirmed the presence of a primary scrotal lipoma, highlighting the importance of considering lipomas in the differential diagnosis of scrotal masses. Surgical excision remains the mainstay of treatment to alleviate symptoms, prevent complications, and confirm the benign nature of the lesion. This case underscores the need for heightened awareness among clinicians managing scrotal pathologies to ensure timely diagnosis and effective management strategies in urological practice.

Ultrasound Diagnostic of Testicular ischemia without torsion in children. Rare clinical observations

Testicular ischemia is the most serious complication of acute pathology of the scrotum, the etiopathogenesis of which is quite diverse and still remains an urgent issue for discussion. The most well-known cause of testicular ischemia is testicular torsion. All other variants are found casually rarely (orchoepididymitis, incarcerated inguinal-scrotal hernia, thrombosis of the veins of the pampiniform plexus, etc.). This paper presents clinical observations of acute testicular ischemia of various etiologies, illustrated with echographic scans and intraoperative images. The publication is supplemented with a brief review of the literature.

Strangulated giant inguinal scrotal hernia with traction perforation at lesser curve of the stomach

A giant inguinoscrotal hernia is typically associated with a low risk of bowel obstruction or strangulation. When the hernia is complicated with acute gastric perforation, it is an exceedingly rare clinical entity. The operative strategy may be definitive at the index surgery or staged. The technical challenge is the severity of the peritoneal contamination contradicting mesh placement, coupled with the loss of domain. Herein we report a 58-year-old man with a long-standing right giant inguinoscrotal hernia, who presented with strangulation with a 1 day history. An urgent midline laparotomy access revealed a large tear over the lesser curvature of the stomach, attributable to choking at the hernia neck. Furthermore, there was severe contamination with total bowels herniation into the sac. We performed a complete reduction of hernia content, primary repair of stomach perforation, and primary closure of midline access and hernia neck repair with posterior wall reinforcement using prolene via an inguinal incision. The patient made an uneventful recovery and was discharged well. The perioperative clinical events and technical strategies are discussed in the current report.

OC-007 RELIABLE AND COST-EFFECTIVE METHOD OF GROIN HERNIA SURGERY, BASED ON OPEN PRE-PERITONEAL APPROACH AND ORIGINAL MESH FIXATION

Abstract Aim To analyze the results of original technique for groin hernia (GH) repair, via open preperitoneal approach (OPPA) had proposed by L.M.Nyhus. Material & Methods There were 161 patients 22–87 years old; in 25 cases GH were recurrent. After OPPA, the spermatic cord, inguinal ligament, interior inguinal ring and abdominal wall defect were always in full vision. GH sack was removed into abdominal cavity. The mesh, having spermatic cord got through a special orifice in it, was fixed to inguinal ligament along it full length, and to rectus abdominis muscle’ lateral edge. Inguinal abdominal wall defect was covered from within by mesh under visual and palpable control. Results Operation time takes 42.5±9.1 minutes for simple GH, and 103.5±21.4 minutes for irreducible inguinal-scrotal hernia. General burden of surgery was correspondent to minimal invasive. Follow-up to work became from 3–5th day. For 12 months 107 (60.9%) patients were followed, no hernia recurrence was found. Conclusions Our method has basic prevalence over: i) possibility of one-day surgery (longer hospitalization if comorbidities); ii) cost-saving because needn't in laparoscopic equipment; iii) simplicity and high reliability because of visual anatomic controlled mesh fixation and positioning for the total closing of groin gap. It may pretend for a proper approval at EHS guidelines. The learning curve and additional points, such as type and quantity of fixation points, best of mesh to be used, should be discussed after the further evaluation.

Ошибки в диагностике туберкулезного орхоэпидидимита.

Introduction. Everywhere there is a weighting of the structure of urogenital tuberculosis. Tuberculosis of the testis and its epididymis is difficult to diagnose because it does not have pathognomonic symptoms; the diagnosis cannot be verified microbiologically in the study of ejaculate or prostate secretion, however, it is possible to detect a pathogen in biopsy specimens or surgical material. Materials and methods. Search results were analyzed in the scientific databases eLibrary, PubMed, Web of Science, Embase, Cochrane Library and PEDro, Wang-fang and Cnki, Edline for the queries «urogenital tuberculosis», «tuberculosis of the male genital organs», «tuberculosis testicles», «tuberculosis of the epididymis», «tuberculous epididymitis», «tuberculous orchiepididymitis», «diagnosis». Results. An isolated lesion of the scrotum is observed with testicular neoplasms, bacterial epididymo-orchitis, genitourinary sarcoidosis, inguinal-scrotal hernia, and hydrocele. Since oncological diseases cause the greatest concern, misinterpretation of clinical and laboratory data and neglect of the epidemic history can lead to an erroneous diagnosis and unnecessary orchiectomy. At best, the patient is initially diagnosed with bacterial epididymo-orchitis and given antibiotic therapy. At the same time, the wrong choice of antibiotic can subsequently make it impossible to identify the pathogen and distort the pathomorphological picture. Description of the clinical case. The article presents a case of incorrect tactics in the treatment of a patient with tuberculous epididymitis, erroneously diagnosed as an «epididymal cyst». Neglect of microbiological data led to the formation of a fistulous form of orchiepididymitis. Conclusions. The diagnosis of tuberculous orchiepididymitis is difficult. With the help of radiation diagnostic methods, tuberculosis of the testicle and apidymis can be suspected; to confirm the diagnosis, identification of the pathogen or the presence of specific pathological signs is required. High vigilance is required for tuberculosis when examining a patient with complaints of enlargement and tenderness of the scrotum.

The left-sided location of Amyand hernia in a 2-year-old child

EDITORIAL COMMENT. The symptom complex presented in the article (a syndrome of edematous hyperemic scrotum in a child with an irreducible left-sided hernia) was undoubtedly an indication for emergency surgical treatment. The cause of the left-sided localization of Amiand hernia requires additional examination – irrigography.Introduction. Amyand hernia or inguinal hernia is the hernia in which the vermiform appendix is located within the hernial sac. There are still debates among researchers what is a true Amyand hernia – strangulation of the vermiform process in the hernial sac of an inguinal or postoperative hernia with its development into gangrenous appendicitis or an inguinal hernia with non-inflamed, or inflamed-altered, or perforated vermiform process. Debates on the surgical treatment, reasonability of appendectomy with an unchanged appendix in the hernial sac and ways of hernia repair are still controversial too. Unfortunately, decisions often have to be made right during surgery since the revealing of vermiform process and its morphology in the hernial sac before surgery is a problematic issue.Literature describes cases of similar hernias, both in adults and in children, but with the right-sided location. Amyand hernias are seen, by different authors, in 0.07–0.13 to 2–4%.Relevance. In the available medical literature, there is no any description of such hernia with the left-sided location, so the authors have considered it appropriate to publish a rare clinical case.Objective. To analyze a rare case of the left-sided inguinal-scrotal hernia with a destructive vermiform process in the hernial sac and to identify possible diagnostic and therapeutic errors occurred during medical care.Material and methods. Clinical case: a 2-year and 8 months old child was admitted to the hospital having emergency symptoms of a left-sided strangulated inguinal-scrotal hernia with a gangrenous-altered vermiform process in the hernial sac and concomitant acute pharyngitis. Anamnesis: child from the first pregnancy which was accompanied by moderate preeclampsia; chronic arterial hypertension of degree II, risk 2; mitral valve prolapse of degree II–III; mild anemia; placental disorders; threats of pregnancy termination. The child was born at 27–28 week gestation with the Caesarean section. It had an extremely low body weight (610 grams), bronchopulmonary dysplasia, congenital pneumonia.Conclusion. Amyand hernia is an insidious pathology. It has specific clinical manifestations, specific anamnesis and child’s life; it is difficult for diagnostics and can lead to tactical mistakes which are described in the given clinical case as an example.

УЩЕМЛЕННЫЕ ГРЫЖИ У ДЕТЕЙ

Inguinal hernia in children is one of the most common surgical diseases, the peak of detection being in the first 3 months of life. Most cases of inguinal hernia are diagnosed during the neonatal period, especially in premature babies [1, 2]. Advances in intensive care and increased survival of preterm infants are increasing the incidence of this pathology in infants. The risk of strangulation in inguinal hernia occurs much more often in children of the first three months of life and, according to different authors, ranges from 28 % to 31 %. By 6 months, this figure regresses to 15-24 %. In premature infants, the incidence of strangulated inguinal hernia is 13–18 %, which is associated with a wider deep inguinal ring [2, 3, 4]. In girls, when strangulated, the contents of the hernial sac are often the ovary and fallopian tube, which undergo torsion and infarction [5, 6, 7]. As the study showed, most often in 66 % of cases, strangulated hernias were found in infants up to 1 year old, since most cases of inguinal and inguinal-scrotal hernias are diagnosed in this age period. 1/3 of the patients with strangulated hernias were girls, in 58 % of cases the strangulated organs had appendages, in 28 % of cases they had organ necrosis, ovariectomies were performed. In 72 % of cases, the loop of the small intestine was infringed, there were no trophic changes in all cases.

Difffferential Diagnosis of Extraskeletal Accumulation of Osteotropic Radiopharmaceutical in Patient with Prostate Cancer with Suspected Ischial Bone Lesions by SPECT/CT

Purpose: To show the additional clinical importance of SPECT/CT method in the complex diagnosis of skeletal system.Material and methods: Patient: male, 75 years. Medical history: At the beginning of July 2021 the patient noticed the presence of blood in urine, and after that he seeked medical assistance from urologist. During medical check up — suspicion on prostate tumor. 09.07.21 PSA > 100 ng/ml. The patient was directed to N.N. Blokhin National Medical Research Center of Oncology for further examination and treatment. Whole body bone scan revealed multiple foci of increased activities of the radiopharmaceutical in the lumbar spine, sacral vertebrae and in the projection of groin and scrotum. After bone scan, SPECT/CT was performed. Metastatic lesions of bone tissue were not confirmed, however, an inguinal scrotal hernia and a nodus in the pelvic cavity (probably of a metastatic) were detected.Conclusion: The use of SPECT/CT made it possible to detect additional changes in the study area. Information about the presence of an inguinal hernia will help prevent complications.

OV04 MASSIVE INGUINAL-SCROTAL HERNIA WITH RETROPERITONEAL CONTENTS AND URETER: VIDEO CASE REPORT OF ROBOTIC REPAIR USING INTRAOPERATIVE FLUORESCENCE IMAGING

Abstract Aim Inguinal hernias containing the ureter and retroperitoneal contents are uncommon. We present a robotic repair of a large inguinal-scrotal hernia containing the ureter as a video case presentation. Material and Methods A 66 year old male with no previous abdominal surgical history presents with a large left sided inguinal-scrotal hernia, as well as smaller ventral and right inguinal hernias. On CT imaging the patient was found to have an ectopic pelvic location of the left kidney with evidence of the left ureter coursing into the hernia with a significant amount of retroperitoneal fat. The patient was taken to the operating room for a robotic bilateral inguinal hernia repair and ventral hernia repair. Results A ureteral catheter was placed preoperatively and instilled with indocyanine green (ICG). The hernias were successfully repaired, and intraoperative fluorescence imaging was successfully used to visualize the ureter as it was reduced with the hernia sac. The robotic platform significantly aided in dissection of the large volume of retroperitoneal fat, while being able to quickly transition to intraoperative fluorescence to clearly visualize the course of the ureter. The patient did well post operatively with no complications. Conclusions We present a video case report of a large ureter-containing inguinoscrotal hernia that was successfully repaired using a robotic preperitoneal approach. Use of the robotic platform and indocyanine green/intraoperative fluorescence imaging were helpful adjuncts in aiding dissection by improving intraoperative visualization of the ureter.

Urinary Bladder in Giant Inguinal–Scrotal Hernia: Robotic-Giant Prosthetic Reinforcement of the Visceral Sac—the Modern Stoppa Technique

Abstract Background: Inguinal hernia is a common surgical disease and is defined as “giant” when descending below the midpoint of the inner thigh of a patient in upright position. These types of he...

Results analysis of laparoscopic TAPP with excision and saving of the hernial sac in recurrent inguinal and inguinal-scrotal hernias

Results analysis of laparoscopic TAPP with excision and saving of the hernial sac in recurrent inguinal and inguinal-scrotal hernias

Gastric strangulation and perforation caused by a giant inguinal-scrotal hernia

Acute abdomen is always a challenging case presentation in an emergency department. A thorough clinical examination and prompt differential diagnosis and required investigations can save patients from potentially life-threatening conditions. We report the case of a 49-year-old gentleman who presented with a rare presentation of acute lower abdominal pain which initially mimicked renal colic (flank pain and dysuria), later as an upper gastrointestinal bleed manifested by massive hematemesis due to the stomach being pulled down into a giant inguinoscrotal hernia resulting in a gastric perforation. The patient underwent life-saving emergency midline open laparotomy. To our knowledge and as per the literature reviewed, this is an uncommon presentation of an acute lower abdomen pain wherein the gastric perforation due to a giant inguinoscrotal hernia masquerade as renal colic and posed a diagnostic challenge to the treating emergency physician.

Hernia vesical en unidad de cuidados intensivos, diagnostico infrecuente. informe de un caso y revisión de la literatura

La hernia vesical se define como una porción de la vejiga urinaria o divertículo que sale a través del orificio de una hernia. Es una entidad rara presente en tan solo el 1 al 3 % de las hernias inguinoescrotales. Su diagnóstico se basa en la alta sospecha clínica y la realización de una prueba de imagen. Se presenta el caso de un paciente masculino de 43 años, con hernia vesical, la cual se manifestó como una masa inguinoescrotal izquierda, relacionada a sintomatología urinaria obs­tructiva, con necesidad de ejercer presión sobre el testículo homolateral para ejecutar la micción. Fue diagnosticado por uretrocistografía re­trógrada y ultrasonido. En las placas antero-posterior y oblicua se evidenció hernia vesical, aproximadamente del 40 % por el conducto inguinal izquierda. En la placa post-miccional, ésta disminuyó su tamaño, pero sin va­ciamiento completo.

Retroperitoneal mass presenting as irreducible inguinal scrotal hernia

Retroperitoneal mass presenting as irreducible inguinal scrotal hernia

Enchancement of Toremifene Anti-Tumor Action by Metformin and Unusual Side Effect of Toremifene in Male Transgenic Mice with HER2-Positive Breast Tumor.

HER2-positive breast tumors are found in 25-30% of patients with breast cancer and are characterized by aggressive course and reduced sensitivity to both chemotherapy and hormone therapy. The aim of the work was to study the possibilities of enhancing the therapeutic effect of anti-estrogen drug toremifene by combining it with biguanide, metformin, on the HER2-positive breast cancer model in FVB/N HER-2/neu transgenic mouse. Male FBV/N mice with intramuscularly transplanted HER2-positive mammary gland tumor from a female mouse of the same strain have been given toremifene (30 mg/kg, orally daily) or metformin (100 mg/kg, orally daily) that had a moderate antitumor effect (decrease the area under the kinetic curve of tumor growth by 1.6 and 1.5 times, respectively, when compared with intact control). Co-administration of these drugs in the same doses had a more pronounced effect (the area under the kinetic curve of tumor growth decreased by 3.1 times compared to intact control; p<0.05). After 10 days, in group receiving toremifene all 10 mice developed inguinal-scrotal hernias, and in group that received toremifene plus metformin - only 5 of 10 (p=0.0325). By the 15th day after the start of treatment, the hernias was also determined in all mice treated with the combination of toremifene and metformin, but the size of the hernial sac was significantly smaller than in those receiving only toremifene - 537 ± 96 mm3 and 1309 ± 120 mm3, respectively (p=0.0001). A possible explanation is the manifestation of collagen-degrading effect of toremifene.

Effectiveness of the Surgical Techniques in Acute Inguinal Hernia

The weakness in the abdominal wallmay be a birth defect or it may be developed later in life when muscles are loosened with age, but also in various intense physical activities. Men are the most affected section of population, 8 times more prone to inguinal hernia than women. In certain moments, when the intestinal tissue descends towards the scrotum, bulging areas occur, accompanied by pain around testes. Appreciation of the degree of dystrophia and anatomic dislocation of the inguinal region made possible to adequately choose the tactics of the surgical treatment of inguinal hernias. Presenting a case of incarcerated right inguinal-scrotal hernia. epiploectomy, followed by treatment of hernia, an alloplastic technique. The choice of the technique to repair an inguinal parietal defect depends on the surgeon.

Effect of Prophylactic Ilioinguinal Neurectomy on Postoperative Groin Pain Following Lichenstein Hernioplasty.

To compare mean postoperative pain post-Lichenstein open hernioplasty with and without ilioinguinal neurectomy at six months. Randomised controlled trail. Surgical Unit-I, Benazir Bhutto Hospital, Rawalpindi, from August 2014 to February 2015. Adult male patients with unilateral reducible inguinal hernia, who consented to the study between the age range of 18-80 years, were included. Recurrent, irreducible or strangulated, or large inguinal-scrotal hernia and those with previous abdominal incision, impaired cognition, peripheral neuropathy, limited mobility and females were excluded. Patients were equally randomised to nerve-preservation and excision groups. Mann-Whitney U-test was applied to find out difference in inguinodynia at 1 and 6 months. There was significant difference in pain at 1 month in the nerve-preservation group (Md=6.00, IQR=4, n=90) and nerve excision group (Md=3.50, IQR=4, n=90), U=2308.00, z=-5.017, p<.001 and at 6 months in the nerve preservation group (Md=2.00, IQR=1, n=90) and nerve-excision group (Md=0.00, IQR=1, n=90), U=3001.00, z=-3.470, p=0.001. Prophylactic ilioinguinal neurectomy significantly reduces groin pain at 6 month as compared to nerve preservation group following Lichenstein hernioplasty.

Large left oblique inguinal-scrotal hernia with bladder involvement in the hernial sac: diagnostics and surgical treatment

Data from a patient's medical history with a sliding inguinal-scrotal hernia with bladder involvement in the hernia sac was studied. The data of general clinical and instrumental examination, intraoperative data and the results of surgical treatment are presented. A large sliding inguinal-scrotal hernia with the involvement of the bladder in the hernia sac has been eliminated. Prostate adenoma of considerable size is preserved. In the postoperative period, a decrease in the severity of urinary disorders. Moved from the scrotum, the bladder is fully expanded. However, it remains unclear the functionality of that area of he bladder which was located in the hernial sac.

ANALYSIS OF SURGERY FOR INGUINAL HERNIA UNDER HERNIA CENTER

The purpose of research - to evaluate the spectrum of surgical procedures performed in patients with inguinal hernias, in clinical practice, surgical hospital in Moscow. Material and methods. Cross-sectional study carried out with sequential selection of all patients with inguinal hernias operated in a planned manner in the surgical clinic CCH № 1 named after N.I. Pirogov in Moscow in the period from September 1, 2017 on December 31, 2017 The study was observational in nature, exclusion criteria were not. The study included 175 patients with inguinal hernias. Found 201 inguinal hernia, made 201 hernioplasty. Results. 42 (20.9%) patients underwent “open” alloplastic - Liechtenstein operation (in all cases a one-sided). Videolaparoscopic intervention conducted 133 patients (26 in the hernia observations wore a bilateral nature, only 159 procedures (79.1%)). TAPP hernioplasty performed in 140 cases (69.6% of 118 patients) TER hernioplasty - in 19 (9.5%, 15 patients). Lichtenstein operation performed usually patients with large hernial ring (3 cm). Among patients who underwent intervention Endovideosurgery dominated patients with hernial ring to 1.5 cm. Also, among patients who underwent open surgery, patients are often met with oblique hernias. Furthermore, Liechtenstein operation was performed in patients with severe concomitant therapeutic pathology, inguinal-scrotal hernia, endotracheal failure of anesthesia. Complications in the immediate postoperative period, fixed in 1 (0.5%) patients - after TAPP formed preperitoneal hematoma. The mean hospital stay of 2.6 days. Signs of relapse of the disease, the formation of chronic pain, septic, and venous thromboembolic complications were recorded. Conclusion. The vast majority of operations for inguinal hernia in the CCH № 1 named after N.I. Pirogov during the reporting period 2017 Endovideosurgery satisfied (79.1%). The widespread introduction of minimally invasive technologies endovideosurgical work according to current clinical guidelines, training of employees, the formation of a significant flow profile allows patients to surgical hospital of the city hospital to assist patients with inguinal hernias at the level of the world standards.

Age-Related and Individual Anatomical Variation in Testicular Topography in Human Fetuses

At present, male infertility remains an urgent medical concern. From year to year, despite advances in methods of diagnosis and treatment, medicine encounters an increasing number of infertile couples with male infertility playing a leading role. Prerequisites for fertility disorders very frequently appear in childhood. Urologists consider cryptorchidism a leading cause of male infertility. The aim of our study was to establish the relationship between testicular descent to the scrotum and the age of the fetus. Material and methods. The study was conducted using 195 specimens of male fetuses aged 4–10 months with 81.0–375.0 mm parietalcoccygeal length (PCL) using the methods of macromicroscopic, conventional, and microslide preparation under control of binocular loupes and morphometry. Results. At the beginning of the fetal period of human ontogenesis (fetuses 81.0–135.0 mm PCL), the right and left testicles are mainly located above the corresponding deep inguinal ring and they are less often located in a region of the iliac fossae. An analysis of topographic and anatomical features of the male reproductive glands in 5-month-old fetuses (136.0–185.0 mm PCL) revealed that the testicles were located within the large pelvis, with the lower end of both the right and left testicles located above the entrance to the deep inguinal ring at a distance that equals the length of the pelvic part of the gubernaculum testis—3.2 ± 0.3 mm (right) and 2.8 ± 0.2 mm (left). In 11 fetuses aged 7 months (231.0–270.0 mm PCL), the lower ends of the testicles and their gubernaculum testis are immersed in the corresponding deep inguinal ring. In eight fetuses, the testicles were within the deep inguinal ring. A combination of many factors contributes to the final migration of a testicle through the inguinal canal into the scrotum (fetuses: 270.0 cm–290.0 mm PCL), including muscle contraction of the anterolateral abdominal wall, an increase in intra-abdominal pressure, contractile capacity of the gubernaculum testis of the testicle, the vaginal process of the peritoneum, and the neuro-muscular system. We believe that the gubernaculum testis is a particularly significant factor in testicular descent to the scrotum. The gubernaculum testis is maximally developed prior to migration of a testicle through the inguinal canal (eighth month of antenatal development), as evidenced by the prevalence of smooth muscle cells over connective tissue elements. An analysis of testicular topography in fetuses aged 9 months (311.0–345.0 mm PCL) revealed that testicles were located in the scrotum in nine fetuses, near the superficial inguinal ring in six fetuses, within the inguinal canal in four cases, and in the deep inguinal ring in one case. In fetuses aged 10 months (346.0–375.0 mm PCL), testicles were located in the scrotum in 13 cases and within the inguinal canal in seven cases. According to our research, the fusion of layers of the vaginal process of the peritoneum occurs in fetuses aged 9–10 months, resulting in the disappearance of the communication of its cavity with the peritoneum. A delay in the fusion of the peritoneal vaginal process layers at the end of the fetal period is an anatomic prerequisite for the occurrence of congenital inguinal-scrotal hernias. Conclusions. It has been found that the rate of testicular descent to the scrotum does not always coincide with the corresponding stage of fetal development. An accelerated development of the gubernaculum testis in fetuses aged 5–8 months is a major factor of heterochronic development of a testicle and subsequent testicular descent into the scrotum.