Irreducible Inguinal Hernia Research Articles

Elective laparoscopic surgery for sigmoid colon carcinoma incarcerated within an inguinal hernia: report of a case

Primary colon carcinoma within an inguinal hernia sac is very rare and most reported cases were found at emergency open surgery for an incarcerated hernia. We report a case of incarcerated sigmoid colon carcinoma diagnosed preoperatively and treated with elective laparoscopic surgery. A 67-year-old man with a 2-year history of swelling of the scrotum and a breast lump was referred to us for surgical treatment of an irreducible left inguinal hernia and a right breast tumor. Blood examination results showed severe anemia. Computed tomography scan and endoscopic biopsy confirmed sigmoid colon carcinoma incarcerated in the left inguinal hernia. Thus, we performed definitive laparoscopic sigmoidectomy and conventional hernia repair for preoperatively diagnosed sigmoid colon carcinoma within an inguinal hernia.

English

Inguinal hernia is the most common hernia seen in females. Only independent risk factors for inguinal hernia in females are positive family history and obstipation. Here we present a case of 60yr old female with irreducible inguinal hernia. On examination an intra-vaginal foreign body was found which was causing patient to strain during micturition leading to chronic increase in intra-abdominal pressure. A herniorrhaphy was done and foreign body was removed intra- operatively. INTRODUCTION : Inguinal hernia in females is relatively uncommon as compared to males but inguinal hernia is the most common hernia in females. The incidence of inguinal hernia in females is <5%. Inguinal hernias are nine times more common in men than in women. (1) The incidence of indirect hernia relates to the congenital weakness at the internal abdominal ring. The sac is formed by the unobliterated portion of the prenatal peritoneal invagination of the canal of nuck that runs along and partly covers the round ligament. Virtually nothing is known about risk factors for inguinal hernia in females. High sports activity is protective in inguinal hernia. Smoking, appendicectomy, abdominal operations and multiple deliveries are not associated with inguinal hernia in females. (2) Inguinal hernia has been reported to be more prevalent in people with low socio-economic status. (3) Inguinal hernias have an approximate incidence of incarceration of 10% and a portion of these may become strangulated. (4) In a study, bowel resection rate in patients with obstructed or strangulated hernias was 15.9%. The need for bowel resection closely correlated with the time interval between the onset of acute symptoms and subsequent operation. (5) Immediate operation should be done in all patients who are ill with incarcerated or obstructed hernia, without attempting reduction.

Abstract 490: Acute Superior Mesenteric Artery Occlusion Presenting as Strangulated Inguinal Hernia

An 85yo woman presented with diffused colicky abdominal pain and vomiting for 12hr. Patient still had bowel movement and passed flatus. Patient was otherwise healthy without past medical or surgical history, and taking no medications. PE: no distress, afebrile, vitals are stable. Cardiopulmonary exam only revealed tachycardia; Abdomen: soft, non-tender, no distension, bowel sounds hyperactive; there was an 8[[Unable to Display Character: &amp;#61620;]]6 cm irreducible, firm but non-tender right inguinal hernia. Labs: leukocytosis, bicarbonate 20. CT abdomen with oral contrast suggested small bowel obstruction secondary to right inguinal hernia. The hernia was then reduced manually. Post the reduction patient had one foul smell watery bowel movement. However, patient deteriorated quickly. Repeat labs: bicarbonate 8, anion gap 23, lactic acid 11, ABG: 7.01/29/246/7/99%. EKG: A-fib with tachycardia. Patient’s blood pressure dropped necessitating IV fluid and vasopressor support. Strangulated hernia with septic shock was suspected and emergency laparotomy was performed. Ascending, transverse and descending colon past the splenic curve were found necroses with foul-smelling turbid fluid intraperitoneally; the small bowel was minimally dilated with a kink 25cm beyond the ileocelcal valve with evidence of previous incarceration. Subtotal colectomy and partial small bowel resection with ileostomy was performed. Pathology confirmed terminal ileum and colonic gangrene; recent mesentery venous thrombi. Despite appropriate therapy, patient continued to be in septic shock and developed multiple organ failure, a stroke, and then brain death. Acute mesenteric ischemia (AMI) is a rare abdominal emergency with high mortality, which could be caused by direct strangulation of the SMA by the inguinal hernia (Tiwary SK et al 2008) or thromoboembolism, e.g., emboli from A-fib, septic emboli, local thrombosis. Since there is no evidence that the incarcerated portion of small bowel had necrosis, this case is mostly likely caused by the paroxysmal A-fib-derived emboli. Due to the lack of typical clinical expression, a high index of suspicion is essential for prompt diagnosis. CT angiography is the current cornerstones for diagnosis of AMI, so treatment can be initiated expeditiously.

English

INTRODUCTION : Dermoid cysts are common developmental anomalies occurring along embryonic fusion lines. Occurrence of this in inguinal region is rare and imposes diagnostic challenge as it confuses the clinician as irreducible inguinal hernia. CASE REPORT : Fifty years male patient presented with irreducible left inguinal hernia. Exploration of the left inguinal canal revealed a cyst (7cm x 5cm) in the floor of the inguinal canal separated from the cord structures. The cyst was opened and foul smelling muddy paste like material came out. Cyst was completely excised. The histopathology was consistent with a dermoid cyst. The patient is doing well at five month follow up. CONCLUSION : Inguinal dermoid cyst mimicking irreducible hernia is rare but possible entity. If such cyst is encountered during hernia operation, complete excision is to be contemplated.

Mesothelial Cyst of the Round Ligament Misdiagnosed as Irreducible Inguinal Hernia

We report the case of a 36-year-old woman who presented with signs and symptoms of an irreducible inguinal hernia. Surgical exploration revealed a mesothelial cyst of the round ligament of the uterus. Mesothelial cysts of the round ligament are rare lesions, frequently masquerading as inguinal hernias, and should be included in the differential diagnosis of any inguinal mass. Clinical findings are those of a groin mass, discomfort, and bulging. Ultrasound and CT scans often demonstrate an aperistaltic cystic mass. Definitive diagnosis is usually made intraoperatively and confirmed histopathologically.

A rare inguinal mass: Round ligament leiomyoma

INTRODUCTIONLeiomyoma of the round ligament is a rare condition and usually appears like an inguinal hernia. PRESENTATION OF CASEWe report a case of a 40 year-old women found to have an inguinal mass which it was finally diagnosed as leiomyoma.The patient was admitted to our hospital with a history of painless groin mass. The mass was thought to be irreducible inguinal hernia. Surgical exploration demonstrated a round ligament leiomyoma. DISCUSSIONA smooth muscle tumor in the round ligament of the uterus in the inguinal region is a rare entity and can be mistaken for an irreducible inguinal hernia. It is a rare condition occurring predominantly in premenopausal middle-aged women. Abdominal, inguinal, and vulvar locations have been described. Surgical excision is the curative treatment. CONCLUSIONLeiomyoma of the round ligament should be entertained as a possible etiology of inguinal mass.

Necrotic Appendix in Amyand’s Hernia: A Case Report

A three-month-old boy was admitted by red, firm, painful swelling in the right groin and vomiting. Surgical repair with appendectomy was performed. We want to emphasize that if the patient has an irreducible strangulated inguinal hernia, appendix or bowel necrosis can be found in the hernia sac.

Sigmoid Carcinoma in an Inguinal Hernia: A Blessing in Disguise?

Colorectal cancer is a rising problem, as the incidence increases with age. In most cases the goal of treatment is oncological resection followed by adjuvant chemotherapy in order to optimize the survival. In this case report we present a 93-year-old patient with a sigmoid carcinoma inside an irreducible inguinal hernia, which was diagnosed prior to surgery. We chose to perform a sigmoid resection through an oblique inguinal incision as a safer alternative to laparotomy.

Chicken bone perforation of an irreducible inguinal hernia: a case report and review of the literature

Foreign bodies causing perforation of hernias are extremely uncommon with only a few cases reported in the literature. Here, we present a case of a patient with ingestion of a foreign body, which was initially managed expectantly but developed a perforation due to the foreign body impacting and causing perforation of an irreducible inguinal hernia. Management of this condition usually involves resection of the involved loop of bowel with repair of the hernia defect at the time of surgery. Patients with ingested foreign bodies who have irreducible hernias have altered anatomy and should be considered for early surgical intervention to prevent complications.

Definitely NOT Just another Hernia

A 77-year-old male presented to our emergency department (ED) with a 3-hour history of acute severe lower abdominal pain, inability to void, a swollen scrotum, and one episode of vomiting. His relevant past medical history included: hypertension, diabetes mellitus, and distant right inguinal hernia repair. Vital signs were: 96.4° F, 101, 22, and 205/90. Examination revealed a normal abdomen and an irreducible left inguinal hernia. Foley catheter placement yielded a scant amount of infected urine that stopped flowing almost immediately and did not resume despite catheter flushing and repositioning. Additional laboratory data did not identify the cause of the patient’s symptoms. An abdominopelvic computed tomography (CT) was performed (Figures 1 and ​and2)2) after which the patient underwent emergent operative reduction of his incarcerated scrotal cystocele. Figure 1. Scrotal cystocele-transverse view. Bladder entering inguinal canal. Arrow marks focal volvulus. Figure 2. Asterisk marks distal obstructed bladder. Complete bladder herniation into an inguinal hernia sac is referred to as a scrotal cystocele. This very rare condition is previously unreported in the emergency medicine literature. Some bladder involvement occurs in 1 – 4% of all inguinal hernias1 and is often an incidental (generally benign) operative finding. Patients with partial bladder herniation may report “double phase micturition.” This occurs when the patient voids then passes more urine by applying pressure to their hernia.2 Scrotal cystocele can be associated with bilateral hydronephrosis, acute renal failure, bladder lithiasis and necrosis, vesicoureteral reflux, and scrotal abscess.1 This inherently serious condition mimics the far more common inguinal hernia containing fat or bowel. Risk factors include: patients over 50 years of age, males, and obesity. ED ultrasound may strongly suggest or confirm the diagnosis. CT is definitive. Due to its associated morbidity, emergency physicians should consider scrotal cystocele in males with obstructive uropathy and an associated inguinal hernia.

Large Lymphangioma Presenting like Irreducible Inguinal Hernia: A Rare Presentation and Literature Review

Large Lymphangioma Presenting like Irreducible Inguinal Hernia: A Rare Presentation and Literature Review

Mesentric cyst- an unusual presentation as inguinal hernia.

Mesenteric cyst is one of the uncommon childhood tumors. Mostly they are asymptomatic. Some of them present with non specific abdominal symptom like chronic abdominal pain very rarely they present as acute abdomen like torsion or intestinal obstruction. We are reporting a very rare presentation of Mesenteric cyst as an irreducible inguinal hernia.

Mesenteric fibromatosis presenting as an irreducible inguinal hernia

Mesenteric fibromatosis is a rare benign tumor of the abdominal cavity. It can present as a sporadic case or as a part of polyposis syndromes. It often infiltrates surrounding structures but rarely metastasizes. Surgical resection is the treatment of choice. The following is a case report of a mesenteric fibromatosis mass presenting as an irreducible inguinal hernia.

Surgical aspects of intestinal tuberculosis in children: Our experience

Tuberculosis (TB) is a major health problem in resource-constrained countries. Intestinal TB is especially notorious as a number of cases have to be dealt surgically, which too have morbidity and mortality. This study was conducted to identify various presentations of intestinal TB necessitating surgical intervention, their management, complications, and outcome in our hospital. This was a retrospective study carried out at the Department of Paediatric Surgery, The Children's Hospital and The Institute of Child Health Lahore, Pakistan, from December 2007 to January 2010. The information about the demography, clinical presentations, investigations, management performed, complications encountered, and outcome of patients with intestinal TB were reviewed. There were a total of 18 patients with intestinal TB who were managed surgically during this period. Five were male and 13 female patients (M : F 1 : 2.6). Mean age of presentation was 8.3 years. Clinical presentations were acute peritonitis in 7 patients, pneumoperitoneum in 5 patients, complete intestinal obstruction in 4 patients, pain in right iliac fossa in 2 patients, and irreducible inguinal hernia in 1 patient. Four patients had concurrent pulmonary TB. Surgical interventions included primary repair of perforation in one, repair of perforation with diversion ileostomy in 8, and merely peritoneal drainage (haemodynamically unstable patients) in 3 patients. The post-operative complications were high output ileostomy in 3, faecal fistula in 1, wound dehiscence in 3, wound infection 5, and prolonged ileus in 1 patient. In three patients stoma was reversed during the same admission. There was one expiry in our study. Acute peritonitis, intestinal obstruction and intestinal perforation are the main clinical presentations requiring surgical interventions. Optimal surgical strategy should be adopted to avoid such pitfalls in the management.

Perforated Sigmoid Colon Cancer within an Irreducible Inguinal Hernia: a Case Report

A perforated sigmoid colon cancer within an inguinal hernia is extremely rare. This unexpected finding is usually discovered during surgery and causes an unavoidable septic evolution. Here, we describe the case of an 84-year-old man who presented with fever, abdominal distension, and a painful, enlarged, left scrotum. A CT showed a left, incarcerated, inguinal hernia containing a perforated sigmoid adenocarcinoma (which was confirmed by histopathology). The possibility of an irreducible inguinal hernia in association with perforated sigmoid colon cancer should be considered in the array of diagnoses. A pre-operative CT scan would be helpful in facilitating an accurate diagnosis.

Haematoma in a hydrocele of the canal of Nuck mimicking a Richter’s hernia

We report a haematoma in a hydrocele of the canal of Nuck in a 69-year-old female. She presented with a right-sided groin swelling, the differential for which included an irreducible inguinal hernia or haematoma given her aspirin and clopidegrel use. Successful treatment involved evacuation of the haematoma with excision of the sac. Despite a high index of suspicion for a haematoma, these swellings should ideally be explored given the potential for co-existence of a hernia.

Migration of an Ingested Foreign Body into the Right External Iliac Vein

Migration of an Ingested Foreign Body into the Right External Iliac Vein

Transverse testicular ectopia associated with incarcerated inguinal hernia: a case report

Transverse testicular ectopia is rarely associated with incarcerated inguinal hernia. A 14-month-old male complaint of irreducible inguinal hernia due to transverse testicular ectopia is reported. The clinical and operative findings and treatment options are discussed. It is thought that surgeons who frequently repair inguinal hernias should be aware of the appropriate surgical management options available to them when this condition is unexpectedly identified during inguinal exploration.

Irreducible inguinal hernia with appendices epiploicae in the sac

Inguinal hernia has a nature to surprise surgeons with its unexpected contents. Appendix epiploicae alone in the hernial sac is a rare entity and that too if hypertrophied and presenting as irreducible hernia is still more uncommon. We report a 52-year-old male with complains of irreducible inguinal mass with little pain on Left side for seven days. A diagnosis of irreducible inguinal hernia was made and the patient was treated laparoscopically by Trans-Abdominal Pre-Peritoneal Mesh Hernioplasty (TAPP). As a surprise, content of the hernial sac was enlarged / hypertrophied appendix epiploicae of sigmoid colon with appendigitis. Patient also had and incidental hernia on the other side, which was repaired in the same sitting. Postoperative recovery of the patient was excellent.

Two patients with tumours presenting as inguino-scrotal masses

Inguinal masses in children may indicate different conditions and pathologies, ranging from congenital anomalies to neoplasms. Although inguinal hernias represent the majority 'masses' in the inguinal canal, there are other rare lesions that may occur. For this reason, irreducible masses shall always receive an appropriate preoperative diagnosis. In this report, we describe two interesting cases of inguinal masses in children first diagnosed as irreducible inguinal hernia. Appropriate investigations before surgery and local surgical excision are therefore recommended.