Palpable Inguinal Mass Research Articles

A spontaneous acute abdomen revealing testicular torsion of an undescended testicle

Torsion of an ectopic testicle is an exceptional condition, occurring mainly in young adults. Its etiopathogenesis is still poorly understood. The clinical picture consists of the sudden onset of abdominal pain without fever, associated with a palpable inguinal mass and an empty scrotum. Medical imaging appears to play a limited role. The management of torsion of an undescended testicle involves urgent surgical exploration. An inguinal incision allows diagnosis, detorsion, reduction and orchidopexy in dartos after lowering the testicle if the testicle is viable and the spermatic cord is of sufficient length.

Intestinal erosions following inguinal hernia repair: a systematic review.

To sum all available evidence regarding mesh or mesh fixation material intestinal erosion following inguinal hernia repair and identify the parameters that lead to early (< 6months) versus late (> 6months) symptom presentation. A systematic literature search of the MEDLINE, Scopus and Google Scholar databases was undertaken to identify relevant studies published up to June 2020. A total of 54 case reports or cases series, incorporating 57 intestinal erosions were identified. Overall, 13 patients (23%) experienced early intestinal erosions occurring during the first 6 postoperative months while the remaining 44 events (67%) occurred after 6months. Patients presented most commonly with symptoms of acute obstruction (n = 18, 31.5%), followed by signs of a palpable inguinal mass in 15 patients (26.3%). The late presentation group exhibited significantly more cases of mesh erosion when compared to the early presentation group (100% versus 46.2%, respectively, p < 0.001). Conversely, early presenting cases were more often associated with mesh fixation material erosion (53.8% versus 6.8% in the late group, p < 0.001) and were more likely to develop symptoms of acute intestinal obstruction (61.5% versus 22.8%, p = 0.01). An open primary procedure was more common in late presenting cases (65.9% versus 7.7%, p < 0.001) while early presentation was linked to minimally invasive primary procedures (92.3% versus 34.2%, p < 0.001). Bowel resection was more frequently required in late presenting cases (84.1% versus 46.2%, p = 0.009). Intestinal erosion from prosthetic material is a rare complication of hernia repair leading to considerable morbidity. Prompt operative repair is key in avoiding catastrophic consequences.

Cryptorchidism with Orchitis Presenting as Incarcerated Hernia: A Case Report

Cryptorchidism with orchitis is a rare condition, for which very few case reports have been published. In this report, the case of a 46-year-old male who presented with left lower abdominal pain that resembled an incarcerated inguinal hernia is described. Contrast enhanced abdominal computed tomography revealed the absence of a testis in the left scrotum and an inflammatory mass in the left inguinal area. Cryptorchidism with orchitis should be included in the differential diagnoses of lower abdominal pain with a palpable inguinal mass.

DaPeCa-1: diagnostic accuracy of sentinel lymph node biopsy in 222 patients with penile cancer at four tertiary referral centres - a national study from Denmark.

To estimate the diagnostic accuracy of sentinel lymph node biopsy (SNB) in patients with penile cancer and assess SNB complications in a national multicentre setting. Retrospectively data were collected from records in four university centres by one medical doctor covering all SNBs performed in Denmark between 1 January 2000 and 31 December 2010. Patients had either impalpable lymph nodes (LNs) in one or both groins, or had a palpable inguinal mass from which aspiration cytology failed to reveal malignancy. Patients were injected with nanocolloid technetium and had a scintigram recorded before the SNB. The primary endpoint was LN recurrence on follow-up. The secondary endpoint was complications after SNB. Diagnostic accuracy was computed. In all, 409 groins in 222 patients were examined by SNB. The median (interquartile range) follow-up of patients who survived was 6.6 (5-10) years. Of 343 negative groins, eight were false negatives. The sensitivity was 89.2% (95% confidence interval 79.8-95.2%) per groin. Interestingly, four of 67 T1G1 patients had a positive SNB. In all, 28 of 222 (13%) patients had complications of Clavien-Dindo grade I-IIIa. Penile cancer SNB with a close follow-up stages LN involvement reliably and has few complications in a national multicentre setting. Inguinal LN dissection was avoided in 76% of patients.

Inguinal Lipoblastoma Mimicking Recurrent Inguinal Hernia

Palpable inguinal mass in children should be differentiated from inguinal hernia, hydrocele, lymph node, and tumor. Though using ultrasonography, fatty tumor would be misdiagnosed as incarcerated inguinal hernia containing fatty component. We experienced the huge inguinal lipoblastoma in 5-year-old girl mimicking recurrent incarcerated hernia. Laparoscopic exploration revealed it was not incarcerated hernia but well demarcated bulging mass from abdominal wall. Mass was about 10×4×3 cm and extended from internal inguinal ring to saphenous opening. It was near total excised because of right external iliac vein injury. Pathologically, it was proven as lipoblastoma containing mature adipocyte with lipoblast and fibrous septa. Postoperatively, we noticed a segmental thrombotic occlusion of external iliac vein. After 1 year, she has no symptom related to occluded vessel. The remained lipoblastoma showed no interval change. Even lipoblastoma has a good prognosis with low recurrence rate, we need careful follow-up.

An unusual cause of dyspareunia

Pancreatic pseudocyst is a complication of acute pancreatitis and it usually manifests with abdominal pain. We report the case of a 45-year-old man with a history of acute pancreatitis who presented with abdominal pain, dyspareunia, and a palpable inguinal mass. Computed tomography scan revealed a large loculated pseudocyst that dissected through the pelvic cavity towards the inguinal canal, compressing pelvic and inguinal structures. When a patient with a history of pancreatitis develops an inguinal mass, a dissecting pancreatic pseudocyst should be suspected.

Hernia Uterine Inguinale: An Uncommon Cause of Pelvic Pain in the Adult Female Patient

Hernia Uterine Inguinale (HUI) is a rare inguinal hernia that contains uterine tissue. It is most commonly reported in the phenotypically normal male infant, presenting with asymptomatic, palpable inguinal mass. It is rarely seen in the female gender in either child or adult, and has not been reported as a cause of pelvic pain. Methods: Case Report/Literature Review. Results: We present a 24yo female with chronic pelvic pain and pelvic mass. Laparoscopy revealed HUI of a rudimentary uterine horn, and excision conferred pain resolution.

Iliopsoas Bursitis following Total Hip Replacement Arthroplasty - A Case Report -

Purpose : To report the clinical, radiological and surgical findings of iliopsoas bursitis, and to suggest an indication for diagnosis and treatment. Materials and Methods : We report two patients with iliopsoas bursitis who underwent THA in between June 1998 to June 2003. All presented with late onset hip joint discomfort, and their diagnosis were confirmed after interdepartmental consultations and with the help of investigations such as interventional angiography and MRI. Their signs, symptoms, investigations and surgical findings were reviewed retrospectively. Results : Iliopsoas bursitis presented with hip pain, leg edema, palpable inguinal mass and ecchymosis, femoral nerve irritation and flexion contracture of hip. The radiographs provided no diagnostic clues but the MRI revealed a well marginated cystic lesion filled with fluid signals. Ultrasonography revealed the anatomic location that enabled guided aspiration and even ruled out vascular compromise. Two patients were treated with USG guided aspiration. One aspirate was serosanguinous and the other was old blood tinged fluid. One patient underwent surgical debridement of the cyst. Surgery revealed an intrapelvic hemorrhagic bursa with an ill-defined cystic wall and intramuscular extension into the iliacus. Conclusion : It is important for surgeons to rule out iliopsoas bursitis when a patient presents with vague hip pain after total hip arthroplasty without any evidence of infection or loosening. A diagnosis of iliopsoas bursitis can be made from the clinical features and ultrasonography.

Missed lipoma of the spermatic cord. A pitfall of transabdominal preperitoneal laparoscopic hernia repair.

Missed lipoma of the spermatic cord is a pitfall unique to the transabdominal preperitoneal (TAPP) laparoscopic hernia repair. This problem occurs when a palpable inguinal mass is noted preoperatively, but no identifiable hernia defect is found at time of laparoscopy and the procedure is terminated. Our group encountered six patients without intraperitoneal defects that had large cord lipomas on preperitoneal exploration. Two of these patients had undergone previous intraabdominal laparoscopy for a proposed TAPP repair, which was aborted when no defect was seen. Both patients were referred for continued symptomatic groin masses, which were subsequently treated by lipoma resection in conjunction with inguinal floor repair. When patients present with a groin mass, exploration of the preperitoneal space and cord structures is indicated during TAPP repair, even in the presence of a normal-appearing abdominal floor. Abandoning a transabdominal approach without exploration of the preperitoneal structures may lead to a failure to identify symptomatic and/or palpable cord lipomas.

A study of metastatic cancer found during inguinal hernia repair.

Among 22,816 inguinal hernia repairs done between 1950 and 1988, 15 patients (0.07%) had metastatic tumors found within their hernias. Inguinal herniation was the initial sign of cancer in six patients. A palpable inguinal mass (53%) and abdominal or groin pain (67%) were the most common presenting sign and symptom, respectively. Primary tumor sites included the gastrointestinal tract (40%), ovary (20%), prostate (13%), mesothelium (13%), and unknown sites (13%). The median patient survival was 20 months and depended on the primary tumor site. Grossly apparent inguinal hernia sac abnormalities should be examined microscopically to avoid missing the diagnosis of metastatic cancer, but routine histologic examination of all hernia sacs is not warranted.

Use of a Marlex fan in the repair of direct and indirect hernias by laparoscopy.

Sixty-seven laparoscopic hernia repairs are described with the use of Marlex mesh in a new fan configuration in 56 cases. This fan is easily constructed and manipulated endoscopically. It offers more surface area of Marlex to the surrounding tissues and occupies more potential space, being conformable to the space left by a hernia sac. In 67 repairs we have had one recurrence at a maximum of 10 months follow-up. One patient had contralateral lower extremity deep venous thrombosis (DVT), one had a palpable inguinal mass, and two patients suffered temporary orchialgia.