Irreducible Inguinal Hernia Research Articles

EGS P15 Perforated Stomach within an Inguinal Hernia: A Rare Case Report and Surgical Management

Abstract Background Inguinal hernias are a common surgical condition requiring urgent medical attention. While complications of inguinal hernias are frequently encountered, the presence of a stomach herniation within this anatomical site is an exceptionally rare occurrence. This rare phenomenon presents diagnostic challenges and necessitates prompt surgical intervention. This case report aims to provide a detailed account of a patient with a perforated stomach within an inguinal hernia, emphasizing the unique clinical presentation, diagnostic dilemmas, and the subsequent surgical management required for such a complex condition. Methods We report the case of an 83-year-old male who presented with severe abdominal pain and a tender mass in the left groin. Clinical examination revealed an irreducible inguinal hernia with signs of peritonitis. CT scan confirmed a giant incarcerated inguinal hernia containing part of the stomach with associated gas and fluid collection. An emergency open hernia repair was attempted but swiftly converted to an exploratory laparotomy. The hernia content was reduced intraabdominally, surprisingly revealing a posterior stomach wall perforation. Damage-control suture repair, washout, and laparostomy were performed. Tragically, he succumbed to multiorgan failure soon after in ITU. Results The occurrence of a perforated stomach within an inguinal hernia is an exceptionally rare and diagnostically challenging entity. Timely diagnosis and intervention are vital to prevent life-threatening complications. Imaging, particularly CT scan, aids in diagnosis and surgical planning. Prompt surgical management, involving hernia reduction and gastric repair, is crucial for optimal outcomes. play a critical role in identifying the gastric perforation and guiding the surgical approach. Conclusions This case underscores the importance of recognizing rare complications, such as stomach herniation in inguinal hernias. Heightened awareness and appropriate use of imaging facilitate accurate diagnosis and guide surgical interventions. Timely surgical intervention is essential in reducing morbidity and mortality associated with this rare presentation.

Mantle Cell Lymphoma Mimicking as Irreducible Inguinal Hernia – A Rare Case Report

Lymphomas are malignant neoplasms originating from bone marrow and lymphatic structures resulting in the proliferation of lymphocytes. It is divided into Hodgkin’s and Non-Hodgkin’s lymphoma. Among Non-Hodgkin’s lymphoma, diffuse large B cell type is the most common, and the follicular variant is next. Mantle cell lymphoma (MCL) is one of the least common varieties of Non-Hodgkin’s lymphoma. It is a case of mantle cell lymphoma presented as an irreducible inguinal hernia. This case report aims to tell us that when it comes to inguinal hernias, most of them do not concentrate on general examination. In this case, it's clear that even if a patient present with an inguinal hernia, it is mandatory to rule out other common clinical findings to prevent misdiagnosis. Even though previous similar cases described were of lymphomas identified in the hernia sac along with the hernia component, it is the first report of mantle cell lymphoma, which presented as an inguinal swelling mimicking an irreducible inguinal hernia. This 72-year male patient, a farmer by occupation, complained of swelling and pain over the right groin. On examination, we found multiple enlarged inguinal lymph nodes raised the suspicion of lymphoma. We proceeded with a CT abdomen and chest, followed by surgery, and mantle cell lymphoma was diagnosed after immunohistochemistry results. The patient was referred for chemotherapy, and a long-term follow-up was done. The patient was doing good. Furthermore, it highlights the significance of the role played by surgeons in screening by sending only macroscopically unusual specimens for microscopic analysis. Here, we present a case of primary non-lymphoma Hodgkin's of the sigmoid colon that manifested as an inguinal hernia that was completely irreducible.

RETROPERITONEAL LIPOMAS PRESENTING AS INGUINAL HERNIA – A DIAGNOSTIC DILEMMA

Introduction - Retroperitoneal lipomas rarely present as inguinal hernia. The part of the tumour that herniates represents only the tip of the iceberg as the main part of herniated mass is not detected clinically. - A Case discussion 60-year-old male presented with complaints of pain over irreducible swelling in left inguinoscrotal region for 3 days which was present for 2 years. Lump was palpable of size ~20x10x7 cm with mild tenderness with ultrasonography suggestive of left inguinal hernia with 2.8 cm defect with bowel and omentum as content with sluggish peristalsis. Patient was posted for hernia repair through inguinal incision with intraoperative ndings where sac could not be visualised with irreducible contents. Hence exploratory laparotomy was done and mass was found to originate from retroperitoneum of size ~ 30 x15x10 cm encasing left testes. Enbloc resection of the retroperitoneal lipoma with left orchidectomy done and sent for histopathology which was suggestive of Retroperitoneal Multilobular Lipoma. - The presented case points out that abdomi Conclusion nal lipomas can be misdiagnosed as irreducible inguinal hernia. Not all groin masses are simple hernias, and hernia cases have the potential to reect distant disease processes.

Transabdominal preperitoneal versus hybrid procedures for treating irreducible inguinal hernias: A retrospective controlled study

BackgroundInguinal hernia is a common condition; however, irreducible inguinal hernias are rare. In this retrospective study, two laparoscopic procedures for irreducible inguinal hernia were compared. Materials and methodsThe study cohort comprised 88 patients who had undergone laparoscopic repair of primary irreducible inguinal hernias between 1 June 2011 and 31 December 2019. The patients were retrospectively divided into Hybrid (Group H) and Standard Transabdominal Preperitoneal (TAPP) Groups (Group S). Patient characteristics, hernia details, and intraoperative and postoperative complications were compared between study groups. ResultsThere were no significant differences between the two groups in baseline characteristics, including age, sex, body mass index, hernia type, operation time, hospital stay, cost, and duration of follow-up. No recurrence or surgical site infection occurred in either group. There were no significant differences between the two groups in incidence of spermatic vessel injury (0% vs. 2.04%, P = 0.370), vas deferens injury (0% vs. 6.12%, P = 0.116), epigastric vessels injury (0% vs. 4.08%, P = 0.202), scrotal hematoma (7.69% vs. 2.04%, P = 0.206), dysuria (5.13% vs. 8.16%, P = 0.575), fever (17.95% vs. 16.32%, P = 0.841), seroma (25.64% vs. 32.65%, P = 0.474), chronic pain (0% vs. 2.04%, P = 0.370), sensation of a foreign body (2.56% vs. 2.04%, P = 0.870), or pain on ejaculation (0% vs. 2.04%, P = 0.370). The incidence of acute pain was higher in Group H than in Group S (43.59% vs. 8.16%, P = 0.000). ConclusionThe hybrid TAPP procedure is a safe and feasible means of treating irreducible inguinal hernias. Though it is associated with a higher incidence of postoperative acute pain than the standard TAPP procedure, it may have advantages in avoiding injuries to the vas deferens and spermatic vessels.

Perforated sigmoid colon adenocarcinoma within an irreducible inguinal hernia: A case report

Inguinal hernia is a potentially occult common surgical condition. Its association with asymptomatic adenocarcinoma is uncommon. However, malignancy-associated perforation of the large bowel within an irreducible hernia is rare. We report a case of 78-year-old male presenting with a long-standing inguinal hernia with a 2-day history of irreducibility. Examination revealed a large left-sided irreducible inguinal hernia. Patient underwent urgent inguinal herniotomy, during which multiple perforations were noted in the sigmoid colon. Patient underwent Hartmann's procedure following bowel resection. Histology revealed a mucinous adenocarcinoma with extensive metastasis involving the resection margins. Elderly patients with long-standing inguinal hernia presenting with acute symptoms should be evaluated further for this rare but sinister diagnosis.

Efficacy of Conservative Versus Surgical Management of Irreducible Inguinal Hernia in Patients Presenting at Mayo Hospital Lahore

Efficacy of Conservative Versus Surgical Management of Irreducible Inguinal Hernia in Patients Presenting at Mayo Hospital Lahore

Neonatal Testicular Torsion (NTT) and Amyand’s Hernia: A Strange Association: About a Case Report

Neonatal testicular torsion (NTT) was first described by Taylor et al. in 1897 [1]. It can be unilateral or less frequently, bilateral. It’s a rare disease that occurs in neonate estimated at 1 in 7500 newborns [2]. Our case report is about a 9 days old male presented with a history of a swelling and irreducible inguinal hernia. Upon admission an ultrasonography was done and reported a right inguinoscrotal hernia. Surgical exploration was performed and the exploration found an extravaginally testicular torsion with a necrotic testicular associated with an inguinal hernia sac. Inside the sac we found a vermiform appendix non perforated known as amyand’s hernia.

Persistent Mullerian Duct Syndrome with Transverse Testicular Ectopia Presenting as an Irreducible Inguinal Hernia

Persistent Mullerian Duct Syndrome with Transverse Testicular Ectopia Presenting as an Irreducible Inguinal Hernia

Ruptured Left Ovarian Teratoma Presenting as an Irreducible Right Inguinal Hernia

Teratomas of the ovary rarely present as inguinal hernias. Teratomas most commonly occur in the gonads or along with midline structures. Although the majority are asymptomatic, complications such as spontaneous rupture are known to occur. We present a previously unreported case of a ruptured ovarian teratoma presenting as an irreducible inguinal hernia. The patient underwent an open exploratory laparotomy with left oophorectomy, and the right inguinal hernia was repaired in the same setting with a separate inguinal incision.

Epiploic Appendagitis as Content in The Inguinal Hernia Sac: A Case Report

Epiploic appendagitis as inguinal hernia content is a relatively rare condition and often an unusual presentation mimicking appendicitis or diverticulitis of bowel strangulation. Appendices epiploicae should be included along with another differential diagnosis when an irreducible inguinal hernia is noted particularly on the left side. Whenever in doubt radiological confirmation with CT is deemed necessary. If epiploic appendagitis is confirmed, it can be managed conservatively, and definitive surgical management can be planned electively. In this article, we present a case of a 76-year-old male with left irreducible left inguinal hernia with inflamed appendices epiploicae as sole content in the sac.

EP.TH.96Recurrent Retroperitoneal Liposarcoma Presenting as Irreducible Inguinal Hernia

Abstract Introduction Retroperitoneal sarcomas protruding though the groin are extremely rare with only about 12 cases reported in the past 31 years to our knowledge. . As the retroperitoneal space communicates with the inguinal canal, large lipomatous tumors, may protrude through this natural weak spot which may present as irreduciible inguinal hernia. Case Report We report a 43 year old male, previously operated for retroperitoneal liposarcoma with 4 cycles of adjuvant chemotherapy and 5 cycles of radiotherapy 4 years back now presented with irreducible inguinal hernia. On examination, a firm fixed mass of about 15 x 10 cm, with indistinct margins was palpable in right hemiabdomen, abdomen was soft with audible bowel sounds. A firm swelling of 8 x 5 cm in right inguinal region extending into scrotum with no cough impulse was also present. On CT imaging a large mixed density lesion noted in Right lower abdomen measuring 16.2 x 14.8 x 23.5 cm. It showed internal fat and solid components and recurrence with herniation through right inguinal canal which is a rare entity. The patient was treated symptomatically, bilateral DJ stenting was done by the urology team and the patient was prepared for debulking surgery. Patient was classified as ASA IV. Unfortunately, the patient died 6th post admission day secondary to cardiopulmonary arrest. Conclusion A retroperitoneal tumor especially a liposarcoma should be ruled out in a large, painless, non-reducible inguinal mass with abdominal complaints. Patients need regular follow up after resection of retroperitoneal liposarcoma for early detection of recurrence.

EP.TH.919Developing A Fast Track Paediatric Herniotomy Service In A District General Hospital

Abstract Introduction Previously to 2011, babies presented as emergency to our Trust with irreducible inguinal hernia at a rate of 1 baby/year. They were referred to our regional tertiary centre for surgery because there is no out of hours Paediatric Surgeon or Anaesthetist. Usually, patients were either, awaiting an appointment to see surgeon or on an 18-week waiting list. The aims of this SIP were to: expedite elective surgery for paediatric inguinal hernias, and prevent emergency paediatric inguinal hernia referrals to our tertiary centre. Method Referrals to paediatric surgical clinics were triaged by the clinic sister. Hernia referrals were expedited to the next available clinic. A provisional date for surgery was arranged ASAP with an identified surgeon and anaesthetist whilst in clinic. Patient demographics and data collected retrospectively. Results A 73% reduction in waiting time for surgery, 1 baby (1.4%) presented as emergency and was referred to our tertiary centre for surgery, the post-op complication rate fell from 6.5% to 0%. Conclusion The success of the fast-track paediatric herniotomy service at our DGH shows that it is possible to provide timely and safe surgery in a DGH in line with the recommendations of the Paediatric Critical Care and Surgery in Children Review (November 2019).

A rare case of irreducible inguinal hernia with intraperitoneal colon perforation

The usual incarcerated organs are small bowel and omentum in Inguinal hernias, it is followed by large bowel and other Intra abdominal structures. The cases with sigmoid colon presenting With perforation are rare in the literature. Moreover intra peritoneal Colon perforation is much rarer case, diagnosed clinically and Managed operatively. Herein we would like to present a very unusual Case of irreducible inguinal hernia with intra peritoneal colon Perforation.

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.

An inguinal hernia imposter

SUMMARY This is a report of one of the many imposters of an irreducible inguinal hernia, a dermoid cyst. It is a rare entity that should be considered in the differential diagnosis of a groin lump when an atypical clinical presentation or groin examination occurs. Complete excision with histological evaluation remains the mainstay of surgical treatment. Keywords: dermoid cyst, inguinal hernia, inguinal canal, incarcerated, hernia surgery

A rare pathology mimicking an irreducible inguinal hernia in girls: cyst in the canal of nuc

A rare pathology mimicking an irreducible inguinal hernia in girls: cyst in the canal of nuc

Inguinal hernia containing hemorrhagic ovarian cyst in an adolescent: A rare case report

Inguinal hernia repair is one of the most common procedures done in the surgical discipline. The hernia sac commonly contains the omentum and small bowel as contents, but structures such as cecum, appendix, urinary bladder, Fallopian tubes, and ovary have been reported. We report an extremely rare presentation in our emergency of a right indirect irreducible inguinal hernia containing hemorrhagic ovarian cyst in an adolescent female. The inguinal region was explored, the cyst was excised, the contents were reduced, and a polypropylene mesh was laid. The preservation of reproductive organs and fertility with prompt surgical intervention is extremely important in such cases of inguinal hernia.

Comparison of Totally Extraperitoneal versus Transabdominal Preperitoneal repair of inguinal hernias

Introduction: Laparoscopic inguinal hernia repair is a tension-free mesh repair that is based on pre-peritoneal approach of repair. It provides mechanical advantage to the surgeon, by being able to place a large piece of mesh and by using the natural force of the abdominal wall to disperse the intra-abdominal pressure over a large area to support the mesh. This retrospective study is aimed to study the demography of inguinal hernia and to compare operating time, complications and postoperative pain between patients undergoing Total Extrapritoneal (TEP) or Transabdominal Preperitoneal (TAPP) repair.Methods: A retrospective comparative study was conducted in patients with inguinal hernia who underwent laparoscopic repair by either TEP or TAPP, between April 2019 to July 2020 at Nobel Medical Collage Teaching Hospital, Biratnagar, Morang. Age, sex, type of hernia, duration of operation, post-operative complications, severity of pain and duration hospital stay were analyzed between two groups of patients undergoingsurgery by either TEP or TAPP.Results: One hundred and five patients underwent either TEP or TAPP during study period. There were 96 males and 9 females. There were 50 patients with right, 40 with left and 6 patients with bilateral inguinal hernia. Four patients had left sided irreducible inguinal hernia, 2 patients had bilateral recurrent inguinal hernia, 2 patients had right sided recurrent inguinal hernia and 1 patient had left sided recurrent inguinal hernia.There was significant difference in duration of operation (TEP 64.43min) / (TAPP 84.46min), p&lt;0. 001. Total duration of hospital stay and postoperative pain were not significant between patients operated with TEPor TAPP. Accidental pneumoperitoneum was noticed in 8 cases, 10 cases of subcutaneous emphysema, 5 cases of seroma and 1 case of scrotal hematoma in TEP group. In TAPP group scrotal hematoma occurred in 4 cases and seroma in 5 cases which was not significantly different from TEP group.Conclusion: TAPP had significantly longer operating time as compared to TEP. However, there was no significant difference in post-operative pain and hospital stay in both group.

Persistent scrotal swelling after laparoscopic inguinal hernia repair: “Omentaloma of the scrotum”

Complete removal of all the contents of a hernial sac is crucial in laparoscopic inguinal hernia repair. We report a case who underwent transabdominal preperitoneal repair for a complete, irreducible inguinal hernia. He had persistent scrotal swelling and new onset scrotal pain post-surgery. Ultrasonography of the scrotum revealed a well-defined hypoechoic scrotal lesion. A magnetic resonance imaging revealed a fat-containing mass lesion, hypointense on T2 fat-saturated image. He underwent exploration of the scrotum and a well-encapsulated mass was excised. The histopathological evaluation revealed a well-encapsulated structure comprising of lobules of fibroadipose tissue with foci of chronic inflammation and foamy histiocytes likely retained omentum from previous surgery. His scrotal pain disappeared post-excision. A missed retained omentum in the hernial sac causes considerable anxiety to patients and diagnostic and therapeutic dilemmas for the treating surgeon. We coined the term "omentaloma of the scrotum" for such a lesion.

Paratesticular Liposarcoma Mimicking Inguinal Hernia: a Case Report

Paratesticular tumors account for approximately 5% of intrascrotal mass, and mostly they arise from the spermatic cord (75%). Here, we report a paratesticular mass having a misleading presentation of irreducible inguinal hernia. A 54-year-male patient presented with complaint of right inguino-scrotal swelling for 5 years. Serum tumor markers were within normal limits. Ultrasound of scrotum reveals inguino-scrotal hernia with omental fat and bowel loop herniating out. Patient underwent right inguinal exploration with high inguinal orchidectomy. Histopathology revealed paratesticular high-grade spindle cell sarcoma, and immunohistochemistry was suggestive of paratesticular liposarcoma.