Left Inguinal Hernia Research Articles

General surgeon’s experience in managing extra pelvic endometriosis

Two unusual cases of extrapelvic endometriosis are discussed here. Both presented themselves to the general surgeons. Case 1 presented with cyclical painful abdominal wall mass at the left iliac fossa region. Ultrasound and computed tomography scan showed a solitary mass at the subcutaneous region and fine needle aspiration cytology revealed endometriosis. The patient underwent wide surgical excision and recovered. Case 2 presented with painless swelling at the left inguinal area whilst being pregnant. Surgical exploration was performed for ‘left inguinal hernia’ but an encysted mass was found in the inguinal canal which was excised. Histopathological examination reported endometriosis. Both cases were subsequently under gynaecological follow-up. It is important for the surgeons to include endometriosis as one of the differential diagnosis in the management of their female patients with mass or swelling.

Ilioinguinal Neurectomy and Chronic Post-Operative Pain After Inguinal Hernia Repair

Ilioinguinal Neurectomy and Chronic Post-Operative Pain After Inguinal Hernia Repair

Initial Experience with Percutaneous Internal Ring Suturing for Indirect Inguinal Hernia in Pediatric Patients.

PurposeThe aim of this study is to review our experience in treating indirect inguinal hernia in pediatric patients.MethodsWe retrospectively studied a total of 43 patients who underwent percutaneous internal ring suturing (PIRS) for indirect inguinal hernia from January 2016 to September 2018. The participants included 29 boys and 14 girls. There were cases of bilateral internal inguinal hernia (n=12), right indirect inguinal hernia (n=16), and left indirect inguinal hernia (n=15). Their mean age was 3.8±2.9 years, and mean body weight was 16 kg. Clinical features and surgical outcomes were analyzed.ResultsMean operating time was 35 min for unilateral inguinal hernia and 40 min for bilateral inguinal hernia. There were five cases of intraoperative bleeding (12%) during needle insertion. In two cases, stress test resulted in escape of gas into the hernial sac and a second suture was inserted. The contralateral patent processus vaginalis was present in six (14% of cases) and closed. Follow-up was 6~30 months. Mean postoperative hospital stay was 1.2 days. No recurrence hernia and postoperative complications were reported.ConclusionAlthough this study investigated a small number of cases and the surgical experience was rather limited, the PIRS technique was shown to have advantages such as a short learning curve and its aid in detecting contralateral hernias. In this study, there were no reports of recurrence, metachronous inguinal hernias, and postoperative complications.

Headache, seizures and loss of consciousness in an elderly male following groin hernia surgery

Headache after lumbar puncture is a common occurrence and have a benign course in the majority. In rare cases, it can be a mani­festation of rare but potentially life-threatening intracranial complications. We discuss a case of 65 years male patient who was operated for left inguinal hernia under spinal anaesthesia, had persistent headache partial response to conservative measures developed one episode of seizures and lapsed into altered sensorium. Imaging findings were suggestive of extensive left frontal-temporoparietal acute SDH with mass effect and midline shift. The hematoma was evacuated and the patient recovered well. Prolonged and persistent post-dural puncture headache complicated by atypical neurological deterioration following spinal anaesthesia should prompt the physician to consider the possibility of intracranial complications and to seek immediate radiological investigations.

Giant recurrent left inguinal hernia with femoral nerve injury: a report of a rare case

BackgroundGiant inguinal hernia(GIH), a rare disease, has brought great challenges to surgeons. GIH is defined as an inguinal hernia that extends below the midpoint of the inner thigh in standing position. However, a giant recurrent inguinal hernia resulting from previous operations that destroy the anatomical structure of the inguinal region is extremely rare. Nerve injury, a complication following inguinal hernia repair, is mostly found in ilioinguinal nerve and iliohypogastric nerve, which often presents as numbness and acute or chronic pain, while postoperative muscular dysfunction results from femoral nerve injury is rare.Case presentationA 77-years-old woman presented with a complaint of a reducible mass in the left inguinal of duration 1 year. The patient had three previous inguinal hernia repairs. Physical examination and auxiliary examination indicated a giant inguinal hernia with femoral nerve injury. After preoperative evaluation and preparation, a transabdominal partial extraperitoneal(TAPE) repair have performed. Finally, the patient recovered and was discharged.ConclusionsIn conclusion, we reported a rare case of a giant recurrent inguinal hernia with femoral nerve injury and made a successful treatment for the patient via transabdominal partial extraperitoneal(TAPE) repair.

Laparoendoscopic Single-Site Totally Extraperitoneal Hernioplasty with Suprapubic Incision: Preliminary Experience

Laparoendoscopic single-site totally extraperitoneal (LESS-TEP) hernioplasty emerged in 2009, and various studies have been performed. However, no significant difference between LESS-TEP hernioplasty and conventional three-port totally extraperitoneal (TEP) hernioplasty has been found. We evaluated the benefits, safety, and feasibility of moving the incision downward to the suprapubic area when performing LESS-TEP hernioplasty. LESS-TEP hernioplasty with a suprapubic incision was performed in 21 patients at the Central Hospital of Shantou, China, from 1 May to 31 August 2019. The patient demographics, hernia type and site, operation time, estimated blood loss, length of surgical incision, defect and mesh areas, conversion to conventional TEP hernioplasty, and postoperative pain scale score were prospectively collected. Only regular laparoscopic instruments were used during surgery. Among 21 patients with hernias (male/female = 19:2), 12 had left inguinal hernias, 8 had right inguinal hernias, and 1 had bilateral inguinal hernias. The mean operative time was 93 min (range, 50–150 min). The mean estimated blood loss was 6.7 ml (range, 5–20 ml). No patients underwent conversion to conventional TEP hernioplasty or developed intraoperative complications. The mean postoperative pain scale score was 2.28 (range, 0–6). The mean hospital stay was 2.28 days (range, 1–6 days). Postoperative fever occurred in one patient and was managed successfully with supportive treatment. LESS-TEP hernioplasty with a suprapubic incision is safe and feasible because of better cosmetic outcomes, potential earlier convalescence, less interference among laparoscopic instruments, and broader indications. The learning curve is considered acceptable.

Hernia Mesh Migration into Urinary Bladder a Cause of Recurrent Stones: A Case Report

We present an 85-year-old male patient with persistent irritative symptoms and recurrent bladder stones after being treated twice with cystolitholapaxy. The patient had a history of left inguinal hernia, repaired 24 years ago. The provisional diagnosis was recurrent stones due to a bladder outlet obstruction, and imaging revealed possible stones inside a bladder diverticulum. We did not expect the stones to be a complication of synthetic mesh, and eventually the stones failed to be crushed by mechanical lithotriptor. The patient was explored, the stones were removed, and we found the mesh penetrating the left wall of urinary bladder (UB) with dense adhesion to the left pelvic wall. For a radical cure, the mesh with part of the UB wall had to be removed and repaired, but in view of this unexpected event, the patient required general after spinal anesthesia. The postoperative procedure passed uneventfully.

Sexually transmitted infective vasitis mimicking left inguinal hernia: computed tomography clarifies diagnosis.

Sexually transmitted infective vasitis mimicking left inguinal hernia: computed tomography clarifies diagnosis.

A young girl with right ovarian torsion and left ovarian ectopy

BackgroundMayer-Rokitansky-Küster-Hauser (MRKHS) syndrome refers to congenital hypoplasia/aplasia of the uterus, the cervix and the upper 2/3 of the vagina, in females with normal ovaries and fallopian tubes, secondary sexual characteristics and 46 XX karyotype. This condition originates from abnormal development of Müller’s paramesonephric ducts in the early stages of embryonic development. Kidney agenesis or malformations are the most commonly associated with unilateral kidney agenesis. Ovaries may be ectopic in 16–19% of MRKHS patients. Primary amenorrhoea, due to the absence of the uterus, is the most common presentation. Female karyotype confirmation is mandatory to differentiate it from complete androgen insensitivity syndrome and 17-alpha-hydroxylase deficiency. The management of MRKHS is multidisciplinary in order to encompass psychological, medical and surgical issues.Case presentationA four-year-old girl, presented to the emergency department complaining of left groin swelling noted 2 days earlier. The patient had recently been evaluated for an episode of acute abdominal pain and vomiting, with a final diagnosis of right ovarian torsion. At that time, the ultrasound imaging was not able to identify the left kidney, the left ovary and uterus. Surgical abdominal exploration confirmed the right ovarian torsion and was not able to identify the left kidney and the left ovary. Only a remnant of the uterus was present. Therefore, the right ovary was removed, and a diagnosis of MRKHS was made. Ultrasound imaging showed a left inguinal hernia. The hernial sac consisted of a solid oval vascularized formation suggestive of an annexe. The patient underwent a surgical procedure to correct the left inguinal hernia. In the operating setting, the presence of a vascularized, ectopic ovary carrying the tuba inside the hernial sac was observed.ConclusionsIn front of a patient with ovarian torsion and anatomical features suggestive of MRKHS, both the ovaries should always be searched for, with a high suspicion threshold for extrapelvic ovary. Identifying the ectopic ovary, in this case, helped to preserve patient fertility, avoiding a possible torsion.

Inguinal herniotomy in a patient with progeria

Abstract Hutchinson–Gilford progeria syndrome or progeria is a rare finding, Herein, we report a 4-year- old boy with progeria who underwent herniotomy and herniorrhaphy for left indirect inguinal hernia. The hernial sac was large and thick with surrounding adhesion. Tissue had an adult texture with very thick vas deference.

A Rare Case of Persistent Mullerian Duct Syndrome and Review of Literature

Introduction: Persistent Mullerian duct syndrome (PMDS) is a scarce type of male pseudohermaphroditism due to anti-Mullerian hormone dysfunction. So, Mullerian duct derivatives such as the uterus, cervix, fallopian tubes, and two-thirds of the vagina are seen in a normal phenotypic and genotypic male. Considering and assessing the clinical manifestations, associated diseases, histopathology, and imaging findings can be clues in the management of such cases. Case Presentation: Here, we describe a case of PMDS with left inguinal hernia and bilateral cryptorchidism and discuss the management and review of the literature. Also, the case has a history of brain mass with a pathologic diagnosis of ganglioneuroma. Is there a correlation between PMDS and extragenital neoplasm? it needs more investigation in the future. Conclusions: Bilateral cryptorchidism could provide us with a hint toward PMDS diagnosis. However, genetic counseling will be required, particularly in parental consanguinity.

Detection and Treatment of Persistent Mullerian Duct Syndrome With Transverse Testicular Ectopia

The coexistence of persistent Mullerian duct syndrome (PMDS) with transverse testicular ectopia (TTE) is extremely rare. Due to a lack of distinctive clinical features in the early stages, PMDS coexists with TTE is usuallydiagnosed when patients are examined for other diseases,including cryptorchidism and inguinal hernia. We present a case of a 51-year-old man who presented with a recurrent left indirect inguinal hernia for 2 years and right congenital cryptorchidism. The patient was diagnosed as PMDS with TTE by preoperative magnetic resonance imaging and underwent laparoscopic resection of the right transverse ectopic testis and Mullerian duct residues.

Malignant mesothelioma of the tunica vaginalis testis: A Rare Malignant Tumor without Asbestos Exposure

: Malignant mesothelioma of the tunica vaginalis testis is an extremely rare and often a deadly tumor. Preoperative diagnosis is very difficult due to lack of specific clinical manifestations, mainly including hydrocele formation and painless inguinal mass. In this abstract we present a case of a young patient with hydrocele and dull pain of left testes, was planned for laparoscopic repair of left inguinal hernia, during which a mass attached to the scrotal cord was discovered. Dissection and release of the mass from the cord structure were done, and postoperative pathological examination revealed a malignant mesothelioma arising from the left tunica vaginalis testis. Case was then referred to oncology center where intraperitoneal hyperthermic chemotherapy with cytoreductive surgery were done.

A Rare Case of Sigmoid Colon Carcinoma in Incarcerated Inguinal Hernia

Incarcerated inguinal hernia is a common diagnosis in patients presenting a painful and nonreducible groin mass. Although the diagnosis is usually made by physical examination, the content of the hernia sac and the extent of the surgical operation may vary and can require multimodal imaging integration (e.g., ultrasonography, computed tomography); the usual finding is a segment of small bowel and, less commonly, large bowel. We present an extremely rare case of a sigmoid cancer incarcerated in a left inguinal hernia and infiltrating the spermatic cord. The patient underwent whole-body computed tomography (CT) with contrast agent injection for staging, followed by a left hemicolectomy paralleled by a unilateral orchiectomy.

Management of infected mesh post laparoscopic transabdominal pre-peritoneal inguinal hernia repair.

A 49-year-old man presented to the emergency department with a six-week history of fevers, weight loss and feeling unwell with anorexia. He had a history of a laparoscopic transabdominal pre-peritoneal left inguinal hernia repair seven weeks prior. An abdominal computer tomography scan showed a collection surrounding the mesh. Initial management involved oral antibiotics and ultrasound-guided drainage. Unfortunately, his symptoms and the collection persisted, and he required surgical intervention. After laparoscopy confirmed the containment of the infection to the pre-peritoneal space, the collection was approached via a moderate skin incision above the inguinal canal. This approach allowed for drainage of the collection, removal of the mesh and a thorough washout and drain placement without disturbing future hernia repair options nor exposing the intra-abdominal compartment to infection. The patient recovered well and was discharged five days after the operation. He did require another brief period of intravenous antibiotics before being discharged once more.

A Case of Left Inguinal Hernia with Endoscopic Incarceration During Colonoscopy Treated by Laparoscopic Surgery and Intraoperative Colonoscopy

A Case of Left Inguinal Hernia with Endoscopic Incarceration During Colonoscopy Treated by Laparoscopic Surgery and Intraoperative Colonoscopy

The Importance of Surgical Timing in Inguinoscrotal Surgical Pathologies

Aim: Various inguinal pathologies can occurred if the processus vaginalis cannot closed fully. The aim of this study was to evaluate all patients who underwent inguinoscrotal surgery operations between 2011 and 2018 in our clinic, in terms of age, gender and accompanying with another operation, retrospectively.Material and Methods: In this study, records of 807 patients who were performed inguinal surgery operations including 558 inguinal hernia repair, 184 orchiopexy and 65 hydroselectomy between 2011 and 2018 at Duzce University, Faculty of Medicine, Pediatric Surgery Department were evaluated retrospectively.Results: Mean age of the 558 patients who underwent inguinal hernia operation was 3.0±3.6 years, and 288 (51.6%) patients were older than 2 years of age. Of the patients who performed inguinal hernia operation, 411 (73.7%) were male and 147 (26.3%) were female. There was a statistically significant difference in terms of inguinal hernia repair side according to gender (p=0.038), and left inguinal hernia repair rate in females was detected higher than in males. Mean age of the 184 patients who performed orchiopexy operation was 4.0±3.4 years old, and only 46 patients (25.0%) who underwent orchiopexy were younger than 2 years of age. Mean age of the 65 patients who performed hydrocele operation was 4.6±4.1 years old.Conclusion: According to the results of this study, it is seen that the community does not have enough information about the right operation time of inguinal hernia and undescended testis, and that the society should be informed about this issue.

A rare content of congenital inguinal hernia: a case report of splenogonadal fusion

BackgroundSplenogonadal fusion (SGF) is a rare congenital malformation that occurs during embryonic development. SGF typically presents as a left-sided scrotal swelling, left inguinal hernia, scrotal mass, or cryptorchidism. Therefore, it is easily misdiagnosed, and unnecessary orchiectomy may occur. This study aimed to report a rare case of SGF.Case presentationA 5-month-old male child presented with a history of obvious left scrotal swelling for 1 month, which progressively worsened 10 h before the hospital visit. The ultrasound examination exhibited a solid mass in the left scrotum, with echo quite similar to that in the testicle and went up into the abdominal cavity through an identical echogenic band structure. After surgical resection, the pathological examination confirmed that the submitted tissue was spleen tissue with extensive bleeding.ConclusionUltrasound can provide important information regarding the diagnosis of SGF. The possibility of SGF should be considered for further differential diagnosis in the case of similar patients.

Colon adenocarcinoma of the inguinal hernia. Case report

Inguinal hernias occupy one of the leading positions in the world, which surgical interventions are performed for. The contents of such hernias can be either a large omentum, loops of the small, large intestine or uterine appendages. In men, they are much more common (a risk of 27 % in men and 3 % in women). Malignant lesions in inguinal hernias have a rather rare occurrence, more often in the sigmoid colon in the left inguinal hernia. The primary malignant disease of the colon located in the inguinal hernia was extremely rarely reported. The first case was reported by Gerhardt and his colleagues in 1938. During an inguinal hernia containing primary colon cancer examination, Medline identified 28 cases of the disease. The sigmoid colon was involved in most cases, but involvement of the caecum and ascending gut was also described.The article describes the clinical case of adenocarcinoma of the sigmoid colon located in the left‑sided irreversible inguinal hernia. The tactics and volume of surgical treatment are proposed. Patient K., 1946 year of birth, entered the surgical department with complaints on the tumour‑like formation presence in the left groin. From the anamnesis of the disease: a hernia existed for many years. St. localis: in the left inguinal‑scrotum region was hernial protrusion sized 40 × 20 cm, hyperaemic, intense, painful, symptom of «cough» impulse was negative, tympanites by percussion. Bowel sounds were not audible over the projection of bulging during auscultation. With a diagnosis of strangulated inguinal‑scrotal hernia on the left and the phlegmon of the hernial sac, patient was taken into the operating room. The contents of the hernial sac were a sigmoid colon with a neoplasm. A Hartmann’s resection of the sigmoid colon was performed. The postoperative period was uneventful. Oncologist consultation was recommended.Detected adenocarcinoma of the colon during surgical treatment of a trapped inguinal hernia, dramatically changes the course of surgery, treatment plan and prognosis for the patient.

Femoroceles—a Rare Differential for the Irreducible Groin Lump: a Case Report and Literature Review

Femoral hydroceles, or femoroceles, are a rare differential for the irreducible groin lump. A healthy 68-year-old lady presents to the surgical outpatient clinic with bilateral groin lumps. CT imaging of the region demonstrates a left inguinal hernia containing unobstructed small bowel and a right inguinal cyst most suggestive of a canal of Nuck cyst. An intraoperative diagnosis of a femorocele was made, and the defect was repaired using a mesh plug. The patient was discharged home the same day and made an uncomplicated recovery in the community. A comprehensive literature review was performed on this pathology—identifying 15 other cases within English medical literature.