Large Inguinal Hernia Research Articles

Arthrogryposis multiplex with deafness, inguinal hernias, and early death: A family report of a probably autosomal recessive trait

We report on three male newborn infants of a highly inbred Lebanese family presenting with a characteristic phenotype: arthrogryposis multiplex, deafness, large inguinal hernia, hiccup-like diaphragmatic contractions, and inability to suck, requiring nasogastric gavage feeding. All three boys died from respiratory failure during the first 3 months of life. Intra vitam or post mortem examinations revealed myopathic changes and elevated glycogen content of muscle tissue. This new syndrome is probably transmitted in an autosomal recessive mode, although X-linked inheritance cannot be excluded.

Strangulated inguinal hernia complicating colonoscopy

Colonoscopy is widely used as a primary investigation of terminal ileal and colorectal disease. Colonoscopy may be more difficult and dangerous in the presence of large inguinal hernias, as loops of bowel and the colonoscope may become incarcerated in the hernia.1, 2 Acute presentation of a strangulated inguinal hernia has not previously been reported as a complication of colonoscopy. A 64-year-old man attended for a colonoscopy as follow-up of previous adenomatous polyps. Colonoscopy was performed uneventfully by an experienced operator. Sedation was with 5 mg midazolam and 50 mg pethidine; air was used for insufflation. The terminal ileum was intubated and a 10 mm pedunculated tubulovillous adenoma was removed from the transverse colon by snare excision. Routine post-procedure care was uncomplicated. Six hours later the patient consulted his general practitioner because of sudden onset central abdominal pain and vomiting. He was referred back to hospital with a provisional diagnosis of colonic perforation. Examination showed a tender mass in the right inguinal region; radiography did not demonstrate any free subdiaphragmatic air. At surgery the diagnosis of a small right indirect inguinal hernia containing a segment of strangulated ileum was confirmed. The ischaemic segment was resected and repair of the hernial defect completed. Recovery was unremarkable. Colonoscopy is a generally safe procedure, with significant complications occurring in 0.3% of cases overall, although haemorrhage can complicate polypectomy in 1% of cases.3 Loops of sigmoid colon within a large left inguinal hernia may pose problems at colonoscopy. It may be difficult to traverse the segment, and the extraction of the endoscope may be problematical.4 This is the first report of strangulation in a previously unrecognised hernia arising as a result of colonoscopy. The temporal relationship between colonoscopy and presentation suggests that the increase in intra-abdominal pressure from insufflation of the bowel exacerbated any predisposing weakness in the abdominal wall and facilitated herniation of the small bowel mucosa. Although such acute complication of a previously unrecognised hernia may be rare, it is important that the possibility is considered. Health-care professionals and patients are aware of perforation as a complication of colonoscopy, but other causes of acute abdominal pain after colonoscopy should be included in the differential diagnosis.

The role of the endoscopic extraperitoneal approach in large inguinal scrotal hernias

The role of endoscopic extraperitoneal herniorrhaphy (EEPH) in the management of giant scrotal hernias has not been well defined, and the technical details relating to operations on such hernias have not been described. We present our experience with 17 patients undergoing repair of giant scrotal hernias. Foley catheter bladder decompression was routinely employed. The Retzius space was developed early in the procedure and hernia sac contents were reduced in all cases. The inferior epigastric vessels were likewise divided in all patients. The average operative time was 76 min and all patients were discharged home the same day. There have been no recurrences on follow-up. There was no mortality, and morbidity was limited to seroma formation in two patients. We conclude that with certain technical modifications, EEPH can be safely employed for the treatment of giant scrotal hernias.

A large inguinal hernia with undescended testes and micropenis in Robinow syndrome

We present a 1 month-old infant with Robinow syndrome and large inguinal hernia, undescended testes and micropenis mimicking penile agenesis. Genital anomalies are common in Robinow syndrome. The ambiguous genitalia appearance may lead to confusion in gender assignment.

A technique of doubling the cremasteric muscle in large inguinal hernia repair in infants and children--a late follow-up.

Between 1969 and 1988, 259 large inguinal hernias in 241 male infants and children were repaired, using a technique of doubling the cremasteric muscle, representing 1.12% of all inguinal hernia repairs in this time period. In a late follow-up, 4 to 20 years postoperatively, 195 patients (81%) with 204 hernia repairs by doubling of the cremasteric muscle were re-evaluated. Postoperative complications occurred in 3 patients, one recurrence of the hernia, one testicular atrophy after an incarcerated hernia and one trapped testicle. The technique of doubling the cremasteric muscle in large inguinal hernia repair in male infants and children represents an alternative and safe operative procedure without further complications.

Inguinal mass in a college football player

A 22-yr-old male college football player presented with a 3-wk history of a mass in his right inguinal area. Originally thought by the athlete to be a groin strain, evaluation revealed a large indirect inguinal hernia. Surgical evaluation was obtained to confirm the diagnosis of a 4-cm opening at the external inguinal ring. The hernia completely and spontaneously reduced in the supine position. The athlete was successfully allowed to participate with the use of a truss and underwent an uneventful surgical repair at the end of the season. The diagnosis and treatment of inguinal hernias are reviewed.

Complete Colonic Obstruction Caused by a Sigmoid Colon Cancer Incarcerated in an Inguinal Hernia Sac

An 85-year-old man with a clinical and x-ray picture consistent with a large bowel obstruction had a large left inguinal hernia with an incarcerated loop of sigmoid colon containing a small annular constricting colon carcinoma. Colonic obstruction due to inguinal hernia alone is so rare that a thorough evaluation should be done preoperatively in any patient believed to have colonic obstruction due to inguinal hernia.

Cranial Sartorius Muscle Flap in the Dog

An anatomic study was performed on canine cadavers to define the blood supply to the cranial sartorius muscle. The vascular supply to this muscle was found to be a single dominant pedicle branching from the femoral artery at the proximal portion of the muscle. This anatomic information was applied in designing a study to determine the feasibility of performing a cranial sartorius muscle flap in the dog. The cranial sartorius muscle was transposed to the caudal abdominal region in four dogs. The muscle flap was based on the singular vascular pedicle defined in the anatomic study. All muscle transpositions were successful on day 19 as evidenced by gross appearance and histologic examination. Grossly, the muscles were well adhered to the recipient sites and were covered by connective tissue. Histologically, the specimens were characterized by viable skeletal muscle fibers, proliferative and maturing granulation and fibrous connective tissue, and mild to moderate mononuclear inflammation. Seroma formation and infection were the two postoperative complications noted. The cranial sartorius muscle flap has potential clinical application for repair of traumatic caudal abdominal hernias and large inguinal hernias in the dog.

Unusual complication of the Fowler-Stephens orchidopexy

A boy who had an intraabdominal testis complicated by a large inguinal hernia is reported. This combination of abnormalities is unusual. Following a Fowler-Stephens orchidopexy the child developed another inguinal hernia.

Hernia en masse

Described is the case of a patient who developed symptoms compatible with small bowel obstruction approximately 16 hours after a difficult self-performed left inguinal hernia reduction. Exploratory laparotomy was performed, and release of an incarcerated loop of ileum was performed. A large inguinal hernia defect also was found, and this was repaired with a Cooper's ligament repair. The patient recovered uneventfully.

Case profile: Bladder herniation and bilateral vesicoureteral reflux

A fifty-three-year-old man presented with the chief complaint of dysuria and frequency. Physical examination revealed the patient to be grossly obese with a huge fat apron. Rectal examination revealed the prostate to be normal, and scrotal examination also was normal. An intravenous pyelogram showed evidence of bilateral ureteral obstruction and bladder displacement (Fig. 1). A cystogram (Fig. 2A) and voiding cystourethrogram (Fig. 2B) revealed the bladder to be herniated into a large inguinal hernia contained in the fat apron and also showed bilateral vesicoureteral reflux. A barium enema showed that there was also sigmoid colon within the hernia. The patient underwent repair of the inguinal hernia with replacement of the sigmoid colon intraperitoneally, and the bladder was repostioned and sutured to the undersurface of the pubis. A urethral Foley catheter was removed on the eleventh postoperative day Postoperative intravenous pyelogram (Fig. 2C) and cystogram (Fig. 2D) films were normal with resolution of the upper tract obstruction and bilateral vesicoureteral reflux. FIGURE 1. Intravenous pyelogram (IVP) showing bilateral distal ureteral obstruction and deviation.

Case profile: Medial deviation of ureters seconi: VFA to large inguinal hernia

Case profile: Medial deviation of ureters seconi: VFA to large inguinal hernia

Testicular feminization syndrome (Androgen insensitivity)

Three children with testicular feminization syndrome have been seen in the past 4 yr. Each presented with at least one large inguinal hernia. The gonad was proven to be a testis by frozen section. Gonadectomy and herniorrhaphy were done. The plan is to remove the second gonad after puberty. The causation and genetics of this condition are briefly discussed.

Cutis Laxa (Generalized Elastolysis) A Report of Four Cases with Autopsy Findings

Four children with cutis laxa (generalized elastolysis) are reported. The first three cases were siblings from a Canadian Indian family and the fourth case was the only affected child in an American Black family. Loose and sagging skin folded over the face, neck and trunk, gave a premature senile appearance. Post-mortem examination was performed on the first three cases. The most common and serious visceral involvement was development of pulmonary emphysema. This was present in two autopsied cases and was demonstrated by chest X-ray in the fourth case. Other abnormalities included large inguinal and perineal hernia, rectal diverticulum and multiple diverticulae of the urinary bladder.

Herniation of Rectus Muscle Through Relaxing Incision

To the Editor.— The McVay hernia repair 1 employing the ileopectineal (Cooper) ligament is frequently used to repair inguinal and femoral hernias. McVay 2 stresses the need for a simple linear incision in the anterior rectus sheath to prevent suture line tension, but admits that some surgeons might be hesitant to make a relaxing incision for fear of creating a defect that could later allow muscle herniation. The relaxing incision must be made as medially as possible, where the external oblique aponeurosis fuses with the rectus sheath. Report of a Case.— A 55-year-old man was operated on for repair of a large indirect inguinal hernia. A McVay repair was performed in which the aponeurosis of the transversalis muscle was sutured to the Cooper ligament, and a 5- to 7-cm relaxing incision was made in the anterior rectus sheath. The patient's recovery was uneventful. During his routine postoperative examination six weeks

GM3 (hematoside) sphingolipodystrophy.

To characterize further disorders involving storage of glycosphingolipids, we studied an infant who had poor physical and motor development, coarse facies, macroglossia, gingival hypertrophy, squat hands and feet, flexor contractures of the fingers, thickened, loose, hirsute skin, bilateral large inguinal hernias, an enlarged liver and spleen, and normal fundi. Shortly after birth the patient became limp and unresponsive, dying at 3 1/2 months of age. The accumulation of ganglioside GM3 (hematoside) was established by quantitative lipid analysis of fresh-frozen post-mortem samples of brain and liver. Higher ganglioside homologues were completely absent. This unusual ganglioside pattern suggests that the defect in GM3 (hematoside) sphingolipodystrophy is in ganglioside biosynthesis, in contrast to previously described sphingolipidoses, which are due to deficiencies of catabolic enzymes. (N Engl J Med 291:929–931, 1974)

GM3 GANGLIOSIDOSIS: A NEW LIPID STORAGE DISEASE

Inherited defects in sphingolipid metabolism are associated with a number of disorders. A one mo. old male (JH) was first seen because of poor physical and motor development, frequent seizures, and an unusual appearance. The first child of young, unrelated Jewish parents, JH weighed 7 1bs. 12 oz. at birth after a normal 8 mo. gestation. He was limp and unresponsive, with coarse facies, macroglossia, gum hypertrophy, squat hands and feet, flexor contractures of the fingers, thickened loose hirsute skin, large inguinal hernia, enlarged liver and spleen and normal fundi. Death at 3 1/2 mo. followed a series of bronchopneumonic episodes. These features suggested GM1, gangliosidosis, which was ruled out by the finding of normal β-galactosidase activity in leukocytes and in a liver biopsy. The activities of acid phosphatase, β-glucosidase, β-N-acetylhexoseaminidase, α-fucosidase, α-mannosidase, and arylsulfatase A were greater than normal. The diagnosis of GM3 gangliosidosis was established by thin-layer chromatographic analysis, which demonstrated the accumulation of GM3 (N-acetylneuraminylgalactosylglucosylceramide) in post mortem samples of brain and liver. The enzymatic basis of the GM3 storage is now under investigation. (Supported in part by the John A. Hartford Fndn. and the Tay-Sachs Assn. of Maryland.)

Cutis strip and patch repair of large inguinal hernias.

THE recurrence rate of large inguinal hernias of many years' duration remains high. The tissue in these cases is extremely poor, and the gap to be bridged is wide. In selected cases, in which a combined repair has been effected by a long strip of deepithelized cutis supplemented with a cutis patch, the rate of recurrence has been strikingly low.Skin was used for the repair of inguinal hernias by Hawley as early as 1889. Perhaps the first to use skin without epidermis as graft to repair hernias were Loewe (1913) and Rehn (1914). Some of the notable contributions made . . .

Phrenicetomy as aid to repair of large abdominal hernias.

During the repair of certain hernias, considerable difficulty may be encountered in replacing the contents of the sac into the abdomen. This is especially apt to be the case when the hernia is very large and of long duration for, under such circumstances, the abdominal cavity may be too small to readily accommodate the viscera that have been displaced from it. In the case of interstitial, inguino-scrotal-abdominal hernia about to be described, the aforementioned difficulty was overcome by performing a phrenicectomy several days prior to hernioplasty. Inasmuch as I was unable to find any report of similar surgical management of a large inguinal hernia, the case appears worthy of recording. REPORT OF A CASE A 60-year-old man first consulted me on May 13, 1953, because of a large, slowly developing right-sided abdominal mass of 30 years' duration. The diagnosis of congenital right inguinal hernia had been made shortly after birth.

Presence of cecum and appendix in scrotum in large indirect inguinal hernia

This case is presented to show that in large inguinal hernias one may encounter the small or large bowel although the latter is not so common. In many cases the appendix may be found in the hernial sac. If the appendicitis should be acute, its differentiation from strangulated hernia may be difficult. In appendicitis the pain may come in spasms and radiate, and in strangulation the pain is usually steady and dull and constantly increasing in severity.