Left Inguinal Ring Research Articles

A case of unilateral hydrocele in a dog secondary to inapparent inguinal hernia

A 6-year, male intact Coonhound, was presented for unilateral scrotal enlargement of roughly 3 months’ duration. His left side scrotum was markedly enlarged and edematous and both testes palpated normal. Rapid slide agglutination test (for brucellosis) and SNAP 4DX (IDEXX Laboratories, Inc., Westbrook, ME) test (for tick-borne disease) were negative. Initial scrotal ultrasonography revealed accumulation of anechoic fluid with hyperechoic flecks and swirling surrounding the left testis. On further ultrasonographic examination, omentum appeared extending through the left inguinal ring and into the scrotum. A case of scrotal hernia with secondary hydrocele was diagnosed. Hydrocele was resolved surgically and the dog returned to full athletic function.

Omento como conteúdo de hérnia inguino-escrotal não estrangulada em garanhão: relato de caso

ABSTRACT Non-strangulated acquired hernias in stallions are rare, especially when the herniated content is not intestinal loops. Thus, the aim of the current study is to describe a case of acquired non-strangulated inguinoscrotal hernia in a stallion, whose herniated content was the omentum. The patient was a Criollo stallion with history of rhabdomyolysis, laminitis and bilateral scrotal volume increase observed in the left scrotal region. The animal presented pain in both thoracic limbs, abnormal blood test, especially hypoproteinemia, and mild pain during palpation in the left inguinal ring region. Hydrocele secondary to hypoproteinemia was suspected. After admission, the animal showed signs of acute abdomen, which were clinically reversed. With this, the animal was subjected to ultrasound examination of the scrotal region, whose findings suggested non-strangulated inguinal hernia, although the content could not be identified. Surgical treatment was chosen in order to identify the herniated content and remove the left testicle. Access to the affected scrotum was performed, in which the presence of fluid and a portion of the omentum was observed surrounding the testis and adhering to it. The animal was discharged after he recovered from the surgery and from laminitis. During the breeding season, the stallion remained with a herd of mares for natural mating. After 15 months of surgery, the animal was reassessed and showed no active signs of inflammatory and degenerative processes in the remaining testis. On this occasion, a pregnancy diagnosis was also performed, and all the mares were pregnant. It is concluded that the presence of omentum as a herniated content does not represent a surgical emergency but can make the reproductive prognosis reserved. In addition, removal of the affected testicle can benefit the spermatogenesis of the remaining testicle.

Paraganglioma of the Spermatic Cord With Spinal Metastasis: A Case Report

A 40-year-old male with presented to the clinic with the chief complaint of right inguinal pain radiating to his right testicle and right thigh with no history of trauma, fever, chills, dysuria, hematuria, or unprotected sexual activity. Physical exam revealed right testicular tenderness with no palpable abnormality of the bilateral testes or spermatic cords. Scrotal ultrasound was performed and was unremarkable for testicular or other intrascrotal pathology. Concurrently, chronic low back pain had prompted a lumbar CT to be performed, which was indeterminate, but subsequent lumbar MRI performed three months later revealed abnormal signals in the vertebral bodies of T12, L3, and L5, concerning for occult metastatic disease or multiple myeloma. PET-CT was performed revealing hypermetabolic lesions throughout the axial skeleton and, most notably, hypermetabolic lesions in the left inguinal and left upper scrotum. At this time, about 4 months after the original visit, physical exam revealed a palpable mobile mass in the left upper scrotum that was distinct from the left testicle, and another mass palpable near the left inguinal ring.

Inguinal hernia causes mortality in an adult American black bear

Herniation of viscera induced by medical intervention has been described in carnivores, yet occurrence of hernias causing wild carnivore mortality, including in bears, remains unknown. We describe an inguinal hernia, intestinal entrapment and rupture, and peritonitis causing mortality in a male American black bear (Ursus americanus). In the autumn of 2014, a free-ranging, adult bear was housed at Virginia Tech's Black Bear Research Center. After 13 days in captivity, the bear showed signs of lethargy and intermittent inappetence consistent with the onset of hibernating behaviors. However, the bear suddenly displayed rapid deterioration and died before medical assistance could be provided. During necropsy examination, a devitalized portion of small intestine was found entrapped in the left inguinal ring. An intestinal perforation was evident near the entrapment area, which caused a subsequent peritonitis. To our knowledge this is the first report of bear mortality due to inguinal herniation with subsequent perforation and peritonitis.

Persistent Müllerian duct syndrome: A case report and review.

Persistent Müllerian duct syndrome (PMDS) is a rare type of male pseudohermaphroditism caused by a deficiency in anti-Müllerian hormone (AMH) or a defect in its type II receptor. The current study reports the clinical data and results of the genetic analysis of a 17-month-old male diagnosed with PMDS. The clinical manifestations of the patient included a left transverse testicular ectopia and bilateral cryptorchidism. Pelvic ultrasonography indicated two testes on the same left inguinal ring and left inguinal hernia and uterine tissue located at the left rear of the bladder. Karyotype analysis detected a 46,XY chromosome pattern and tests determined that the level of AMH was increased. Gene sequencing of AMHR-II indicated a compound heterozygous nucleotide variation and identified two novel mutations. The c.1184 (E9) to c.1185 (E9) CT deletion mutant gene originated from the father of the patient. This mutation causes a frameshift resulting in a truncated protein. The c.1388G>A (E10) mutant site was derived from the patient's mother and caused a change in p.463, R>H, resulting in the alteration of the structure of the protein, which subsequently induced a conformational change in AMHR-II. The results of the current study may help to further understanding of the PMDS genetic profile.

P-03-061 Managing the complication after a combined treatment model of erectile dysfunction and Peyronie's disease

A 64 years old man admitted to our clinic with erectile dysfunction and penile curvature. Penile revascularization and penile plication with pericardial greft was performed. The patient was discharged at postoperative day 9 because of hemorragie. After 10 days, he admitted again with a hematoma on the site of surgery and pain. The man treated with penile vascularization and penile plication admitted to our clinic with a hematoma and pain on the site of his surgery after 19 days from the operation.He has a history of left inguinal hernia repair. He was hospitalized. Ultrasuond examination revealed a 14x4.5 cm hematoma begining from left inguinal ring to penile root.After that computerized tomography was performed but there was no sign of inguinal hernia or abscess. Thereafter with the help of a ultrasound the hematoma was aspirated and about 100 cc hematoma was drained.Biochemical examination did not reveal a lymphatic drainage and was just same like hematoma. He had no fewer and during his stay ceftriaxone 2x1 gr/day was given for 3 days and discharged after 4 days.

Anaerobic peritonitis caused by Clostridium septicum as a complication of routine castration in a 2‐year‐old Warmblood horse

SummaryThis case report describes an unusual case of anaerobic peritonitis in a 2‐year‐old horse following castration. The horse was evaluated 2 weeks following castration for signs of acute, severe abdominal pain and swelling surrounding a previous castration site. Physical examination revealed marked scrotal and ventral abdominal oedema that was cool and crepitant upon palpation. Ultrasonographic evaluation was unrewarding because gas shadowing distributed throughout the subcutis prevented imaging of the abdominal cavity. Ventral midline celiotomy revealed a copious amount of malodorous, serosangious, cloudy peritoneal fluid that was submitted for culture. Abdominal exploration revealed the gastrointestinal tract to be in its anatomically correct position. There was diffuse petechiation of the small intestine and large intestine, oedema and crepitant swelling surrounding the left inguinal ring and body wall. The abdomen was lavaged with 10 l of sterile saline prior to closure of the celiotomy and the left castration incision was opened digitally, releasing a large volume of serosanguinous fluid and gas that flowed freely from the incision site and deeper inguinal tissues. The horse was placed in the recovery box where it suffered cardiac arrest. Culture of the peritoneal fluid revealed heavy growth of Clostridium septicum. This case of anaerobic peritonitis represents an unusual complication following castration not previously reported in the horse.

Laparoscopic Single-stage Fowler-Stephens Orchidopexy in a Case of Orchidogastric Fusion

This report describes laparoscopic Fowler-Stephens orchidopexy for cryptorchidism resulting from orchidogastric fusion in an infant born with gastroschisis. At 11 months of age, the left testicle remained impalpable, and diagnostic laparoscopy was performed. Intraoperatively, a normal-appearing testicle was found attached to the stomach. The testicle was dissected, mobilized down to the left inguinal ring, exteriorized through a transscrotal trocar, and subsequently fixated in the lower left scrotum. On follow-up 5 months later, both testicles were normal in size and location. Single-stage laparoscopic Fowler-Stephens orchidopexy is easily accomplished in cases of orchidogastric fusion resulting from a long vas deferens.

Cystic lymphangiomatous hamartoma masquerading as massive ascites

We report a 4-year-old boy presenting with a tense massive ascites and large hydrocele. History and physical examination were unremarkable. Routine laboratory studies were normal. Abdominal ultrasonography revealed massive ascites. Contrast CT was suggestive of a large cyst covering the entire peritoneal cavity. At laparotomy, a large cystic tumor was found extending into the scrotum through the left inguinal ring. Histopathologic examination diagnosed the tumor as a cystic lymphangiomatous hemartoma. Although abdominal lymphangiomas are seen in children, but presenting as massive ascites with hydrocele is very rare.

Preoperative detection of splenogonadal fusion by CT

Splenogonadal fusion (SGF) is a rare congenital anomaly. It is typically identified at orchiectomy for a suspected testicular tumor or during orchiopexy. The purpose of our study is to proposal possibly preoperative diagnosis of continuous-type SGF by contrast-enhanced spiral computed tomography (CT). Pre- and post contrast-enhanced CT scan at pelvic and scrotal regions was performed to a 15-month-old boy who had a left scrotal mass for evaluation. The slice collimation was 5 mm and the pitch was 3.75. Curved planar reconstruction was done after scan. Before administration of the contrast medium, a homogeneous noncalcified soft mass was seen on the left testicle. After administration of the contrast medium, the mass was prominently enhanced. It extended upward through the left inguinal ring into the left lower abdomen. Preoperative diagnosis of continuous-type SGF by contrast-enhanced spiral CT is possible depending on the basis of its characteristic CT features.

INGUINAL HERNIA OF THE BLADDER.REPORT OF A CASE. REMARKS ON DIAGNOSIS.

Patient. —H. E. R., aged 40, locomotive engineer, on Dec. 24, 1903, jumped from his engine, which was about to leave the track. He struck on his feet, which slid out from under him, allowing him to fall heavily on his buttocks. Examination. —Dr. R. A. Kerr, of Peoria, who examined him the same day, reports very large left inguinal ring. No previous history of hernia. No protrusion of abdominal contents. About a month later I saw the patient and he plainly had, at that time, a left inguinal hernia. I arranged to operate on him at a later date to suit his convenience. On the right side, there was no sign of a testicle either in the scrotum or in the inguinal canal, and the patient said there never had been. Operation. —June 16, 1904. After making the usual incision, a thick-walled sac, containing much fat, was separated,