Right-sided Hernia Research Articles

Laparoscopic Extracorporeal Ligation of the Internal Inguinal Ring by a Spinal Needle: a Simple Method of Hernia Repair in Children.

Laparoscopic repair has emerged recently as an alternative technique for hernia repair in children. Various methods of repair have been described. Basic principle is to close the internal inguinal ring either by intracorporeal or by extracorporeal suturing. The objective of this study is to describe and evaluate the outcome of a simple technique of internal ring closure by a spinal needle. A total of 43 hernias in 41 patients were repaired. A prolene thread was passed percutaneously around the internal inguinal ring by threading it though a spinal needle under laparoscopic control. The suture is then tied extracorporeally in the subcutaneous plane. There were 15 female and 26 male patients in the age group of 1½ to 12years. Right-sided hernia was present in 31 cases and left-sided hernia in eight cases, and two cases had bilateral hernia. All cases were repaired successfully. There was no intraoperative or postoperative complication. This new technique has all the advantages of laparoscopic hernia repair in children (minimally invasive, less pain, less complication, and cosmesis). In addition, the method is simple and it does not need any special equipment or advanced laparoscopic skill.

Delayed Presentation of Traumatic Diaphragmatic Hernia: The Evaluation of Surgical Treatment Results

Introduction: Diaphragmatic hernia could be caused by congenital disorders, blunt trauma or penetrating injuries. The diagnosis of traumatic diaphragmatic hernia is normally neglected during the first presentation leading to late complications and considerably increased mortality and morbidity among the patients. Materials and Methods: In this retrospective, descriptive study, we reviewed the medical records of patients presented with traumatic diaphragmatic hernia who had undergone surgical operations between 1982-2015 in Ghaem Hospital and Omid Hospital affiliated to Mashhad University of Medical Sciences, Iran. The studied variables included age, gender, clinical symptoms, location of hernia, involved organs, type of imaging modalities, surgical techniques, length of hospital stay, mortality rate and surgical complications. Results: In this study, 38 patients were diagnosed with traumatic diaphragmatic hernia consisting of 28 men and 10 women. In total, 79% and 21% of the patients suffered from penetrating trauma and blunt trauma, respectively. In addition, left-sided, right-sided and bilateral hernias were present in 33%, 4% and 1% of the patients, respectively. The most frequently herniated organ was the stomach, and the most common clinical symptoms were abdominal pain (84%) and dyspnea (53%). Initially, chest radiographs were performed on all the patients, and thoracotomy was performed to repair diaphragmatic tears in all the cases (100%). In this study, 3 patients had previously undergone Hartmann’s operation for gangrenous herniated colon, and devolvulation of gastric volvulus had also been performed on 3 patients. The main post-operative complications were reported to be pneumonia and respiratory insufficiency (2 cases), and the mean length of hospital stay was 6 days (5-8 days) which was longer (1-2 months) in patients with gangrenous bowel (3 patients). Furthermore, no mortality was reported during the course of hospitalization in these patients. Conclusion: According to the results of this study, patients presented with blunt or penetrating traumas to the upper abdomen or lower chest require urgent attention as to immediately rule out diaphragmatic hernia in order to prevent later complications and mortality and morbidity among these patients.

Massive Inguinoscrotal Hernia Associated with Acute Renal Failure Complicated Acute Pyelonephritis

We report a 50-year-old man was brought to our Emergency Department due to fever and dyspnea for 2 days. The patient had difficulty in walking and was bed-ridden in the past 5 days due to massive right inguinoscrotal hernia. He had difficulty in micturition in the past 2 days. He was febrile with a body temperature of 39.5°C, a blood pressure of 82/50 mmHg, a pulse rate of 122 beats/minute, and a respiratory rate of 22 breaths/min. Physical examination showed left-sided costovertebral angle knocking tenderness and a large right-sided irreducible inguinoscrotal hernia. Initial laboratory examination revealed abnormalities as follows : l0 eukocyte counts 28.8 × 10 [3] /μL; procalcitonin >200 ng/mL; blood urea nitrogen 77.7 mg/dL; and creatinine 10.6 mg/dL. Computed tomography (CT) of abdomen displayed a large right inguinal hernia containing small and large intestine with compression on junction of bulbous and pendulous urethra. Coronal view of CT reviewed swelling and fat stranding of left kidney which indicated acute pyelonephritis.

İnce Barsak Tıkanıklığının Nadir Bir Sebebi: Obturator Herni

Obturator hernia is an uncommon disease and its diagnosis is challenging. It is more prevalent in thin, multiparous, elderly women. In this case report a 93-year-old woman patient with a right-sided strangulated obturator hernia was discussed with review of the relevant literature.

A Rare Case of Richter's Variety of Obstructed Femoral Hernia in a Male.

Femoral hernias are elusive conditions that, despite having life-threatening complications, are often undiagnosed in asymptomatic patients. They are less common than inguinal hernias and occur more frequently in females [Purushotham et al. (2014) J Evol Med Dent Sci 3(05):1160-1163]. In the first place, femoral hernia in a male patient is itself, a very rare clinical presentation, let alone complications like obstruction or strangulation in the second place. Thus, despite the fact that femoral hernias account for only 2-4% of all groin hernias, their timely and correct diagnosis is vital due to the increased mortality associated with emergency surgery for their complications [Arkoulis et al. (2012) Ox J Med, J Surg Case Rep 2012(6):6]. This, however, is not always easy, where mortality has been found to be tenfold. Here, we present a case of right-sided obstructed femoral hernia of Richter's variety in a male of 52years of age.

Inguinoscrotal hernias involving urologic organs: A case series.

We report 2 cases of inguinoscrotal hernias involving urologic organs. The first case involved an elderly gentleman with a history of micturition by squeezing his scrotum. He was diagnosed as having a right-sided indirect inguinal hernia involving the right ureter and bladder. Treatment was surgical. The second case involved an achondroplastic male who presented with acute kidney injury. He had bilateral hydronephrosis and ureteric obstruction secondary to an ureteroinguinal herniation bilaterally. The presentation, diagnosis, and treatment of inguinoscrotal hernias involving the bladder and ureters are discussed.

Adult right-sided Bochdalec hernia containing perforated colon

Introduction The literature describes less than a dozen cases of right-sided diaphragmatic hernias. Herein, we present an unusual case of this kind in an adult patient. The hernial contents included the liver, omentum and large bowel.

Schley’s inguinal hernia repair: a single unit’s experience of a forgotten technique

This study was done to assess the effectiveness of Schley's inguinal hernia repair. It is a retrospective study analysing the outcome of patients who received the said technique over a period of 1 year at our institution. The minimum and the maximum follow-up periods were 2 and 3 years. The patients who underwent the above technique in 2011 were reviewed retrospectively in December 2013 by going through the hospital records and examining the patients in person. 105 patients had undergone surgery in 2011. The majority of them had right-sided hernias and were in 40-59 age group. Two cases of wound infection, one case of haematocele and one hernia recurrence were noted. Operating on the recurrent hernia was straightforward. Schley's inguinal hernia repair is an effective technique with favourable outcome.

Traumatic lumbar hernia: can’t afford to miss

We describe the radiological and surgical correlation of an uncommon case of a traumatic lumbar hernia in a 22-year-old man presenting to the emergency department following a motor vehicle accident. Computed tomography (CT) of the abdomen revealed a right-sided traumatic inferior lumbar hernia containing a small amount of fat through the posterior lateral internal oblique muscle with hematoma in the subcutaneous fat and adjacent abdominal wall musculature, which was repaired surgically via primary closure on emergent basis. The purpose of this article is to emphasize the importance of diagnosing traumatic lumbar hernia on CT and need for urgent repair to avoid potential complications of bowel incarceration and strangulation.

Traumatic lumbar hernias: do patient or hernia characteristics predict bowel or mesenteric injury?

Traumatic lumbar hernias are rare but important injuries to diagnose in blunt abdominal trauma, both because of delayed complications of the hernia itself and because of well-documented association with bowel and mesenteric injuries. No study to our knowledge has determined whether specific features of the hernia-size of the wall defect, inferior or superior location, or the side of the hernia-bear any predictive value on the presence of underlying bowel and mesenteric injury. A retrospective query of the radiology information system yielded 21 patients with lumbar hernias which were diagnosed on CT. These were reviewed by three radiologists to confirm the presence of an acute lumbar hernia and to determine the size and location of the hernia. The patients' medical records were reviewed to determine the presence of operatively confirmed bowel and/or mesenteric injuries, which occurred in 52 % of patients. A significant (p < 0.001) difference was found in the frequency of bowel and/or mesenteric injury with hernia defects greater than 4.0 cm (100 %) and those less than 4.0 cm (17 %). Larger hernias also resulted in more procedures (p = 0.042) and a trend towards longer ICU stay, but no difference in injury severity score (ISS) or overall hospital stay. No significant difference was seen in the frequency of bowel and/or mesenteric injuries based on side or location of the hernia, though distal colonic injuries were more commonly seen with left-sided hernias (50 %) compared to right-sided hernias (18 %). Although based on a small patient population, these results suggest that larger traumatic lumbar hernias warrant particularly close evaluation for an underlying bowel and/or mesenteric injury.

Strangulation of a Meckel’s diverticulum in a femoral hernia (Littre’s hernia)

Femoral hernia is usually presented as a flexible, round, domed shape lying on the medial side of the thigh about 2–3 cm below the inguinal ligament. Among the external hernias, femoral hernia is the second most common inguinal hernia. Its prevalence reaches 20%. Among all inguinal hernias, femoral hernias are characterised by a high level of incarceration and strangulation. This can be as high as 60%. We would like to present a case of 71-year-old patient who was admitted to the Clinic urgently due to strangulation of Meckel's diverticulum in a right-sided femoral hernia. Strangulation of Meckel's diverticulum in femoral hernia is an extremely rare entity. It was described for the very first time in 1700 by Littre.

直腸腫瘍を契機に発見された無症状の成人右側Bochdalek孔ヘルニアの１例

直腸腫瘍を契機に発見された無症状の成人右側Bochdalek孔ヘルニアの１例

Successful use of caudal anesthesia and light sevoflurane mask ventilation for inguinal hernia repair in an infant with multiple large intrapulmonary cysts.

Successful use of caudal anesthesia and light sevoflurane mask ventilation for inguinal hernia repair in an infant with multiple large intrapulmonary cysts.

Amyand′s hernia masquerading as a strangulated inguinal hernia: A case report and literature review

We report a rare case of a 62-year-old male who presented to surgical emergency department with the complaints of sudden onset pain and swelled in the right inguinal region with nausea, vomiting and abdominal distension. There was a history of a reducible swelling in the right inguino-scrotal region for the last 1 year. Based on history, clinical examination and investigations a provisional diagnosis of right-sided strangulated inguinal hernia was made and patient was planned for an emergency surgery. On the exploration, the hernial sac revealed a gangrenous vermiform appendix and the diagnosis of Amyand's hernia was made. Appendectomy was performed through the same incision, and hernial repair was done using a polypropylene mesh.

Herniation of the Lung: A Case Report

BackgroundChest pain accounts for a significant number of visits to the Emergency Department. Lung herniation is an uncommon cause of chest pain, but one that is easily treated. Patients may complain of pain or present with ecchymosis or a visible bulge in the chest wall. Most lung herniations are located anteriorly or at the thoracic inlet, due to the lack of musculature in these areas. We present a unique case of a right lateral lung herniation and subsequent development of a spontaneous right-sided transdiaphragmatic hernia. ObjectivesTo discuss the presentation of a patient found to have a spontaneous lung and bowel herniation, and to review the literature regarding these entities. Case ReportA 61-year old gentleman with a history of chronic obstructive pulmonary disease and previous long-standing smoking history presented with complaints of right-sided chest pain and cough. He was found to have a spontaneous right lateral lung herniation. This was managed expectantly, but the patient subsequently developed spontaneous right-sided diaphragmatic rupture and herniation of bowel contents through the chest wall. ConclusionTo our knowledge, this is the first reported case of a patient presenting with spontaneous right-sided lateral lung herniation and spontaneous right-sided transdiaphragmatic hernia. This case is unusual given the location of the hernias, and is unique in the spontaneous development of the hernias without any inciting history of trauma.

Obstructed hepatic flexure contained in a right-sided inguinoscrotal hernia resulting in caecal perforation

Inguinal hernia often presents as an emergency with obstruction and subsequent strangulation. We report a unique case where an inguinoscrotal sliding type hernia contained the entire hepatic flexure as its lead point, resulting in acute colonic obstruction and caecal wall perforation.

Recurrence and complications of pediatric inguinal hernia repair over 5 years

Introduction and aim Inguinal hernia is one of the most common pediatric diseases in children and it presents most commonly during the first year of life. The aim of this study was to determine epidemiologic indexes and complications of inguinal hernia repair in pediatric patients who underwent inguinal hernia surgery. Patients and methods This retrospective study was carried out in the Imam Khomeini and the Abuzar hospitals. All inpatients who underwent surgery for inguinal hernia from 2003 to 2004 were included in this study. Their hospital records were reviewed till 2007 for age, sex, wound infection, recurrence, and other complications. The v2-test was used for analysis using SPSS, version 13.0. Results In this study, 269 children were included. Of all the patients, 237 (88.1%) were boys and 32 (11.9%) were girls (P < 0.001). The median age at the first reference to the surgeon was 2.93 years. Right-side and left-side inguinal hernia was observed in 136 (50.55%) and 92 (34.20%) cases, respectively. Bilateral inguinal hernia was observed in 41 (15.25%) cases. The frequency of recurrence was 2.2%, and was observed only in boys. Postoperative complications were observed in 5.2% of the cases. The most common of them was anesthetic complication. Conclusion Most of the cases involved male patients. All of the recurrences were in male patients. Postoperative complications were observed in 5.2% of the cases. Keywords : complication, inguinal hernia, pediatric, recurrence

Case Report: a Rare Case of Amyand’s Hernia Presenting in a 3-year-old Male Child

The finding of the vermiform appendix in an inguinal hernia has an incidence of approximately 1%. The condition is given the eponymous name "Amyand's hernia." However, in just 0.08%, the condition is complicated by an acute appendicitis. The clinical presentation varies, depending on the extent of inflammation of the appendix, and is most often misdiagnosed as an incarcerated inguinal hernia. As such, it is rarely recognized prior to surgical exploration. We report a case of Amyand's hernia in a 3-year-old child who presented as a right-sided congenital hernia with pain in the right groin. He underwent herniotomy, which revealed that the hernia sac containing elongated inflamed appendix appeared with some adhesions to sac, lying in the inguinal canal.

Small Bowel Herniation Through a Spigelian Defect Within 48 Hours After Laparoscopy

Spigelian hernia is extremely rare, with an incidence of 1% to 2% of all abdominal hernias. Herein we report the case of a woman with a spigelian hernia occurring within 48 hours after laparoscopic salpingo-oophorectomy. The patient had abdominal pain, nausea, and abdominal mass. An abdominal series revealed multiple dilatations of the small bowel, compatible with a small bowel obstruction, and computed tomography demonstrated a right-sided abdominal hernia with small bowel obstruction. The diagnosis of spigelian hernia was made during a second surgery. The bowel was reduced and the fascial defect repaired. The postoperative recovery was uneventful. It would seem that pneumoperitoneum during laparoscopic surgery and the trauma of trocar insertion can trigger development of a spigelian hernia.

Fetal Umbilical Vein Deviation in Congenital Diaphragmatic Hernia

Deviation of the intra-abdominal umbilical vein has been described as a marker of congenital diaphragmatic hernia (CDH) and has been shown to help identify liver herniation into the fetal chest. The purpose of this study was to quantify the degree of deviation in affected fetuses and to determine the accuracy of measurements for diagnosing liver herniation. In patients undergoing prenatal sonography for CDH, the midhepatic portion of the umbilical vein was identified, and the distance between the lateral edge of the vein and the inner rib margin was measured. The same was done on the right, and the ratio of the left to right measurement was termed the "umbilical vein ratio." The accuracy of the umbilical vein ratio for predicting the presence and side of the hernia and for diagnosing liver herniation was determined. All but 1 of the cases with right-sided hernias had an umbilical vein ratio above the normal range, and all had liver herniation. Of those with a left-sided hernia, only 2 had a ratio within the normal range. Of those with a left-sided hernia, an umbilical vein ratio less than 0.4 was shown by receiver operating characteristic curve analysis to be the best predictor of liver herniation. This cutoff had sensitivity of 89% for predicting herniation, with a false-positive rate of 14%. Ninety-three percent of right-sided CDH lesions and 98% of left-sided lesions have an umbilical vein ratio outside the normal range. This finding shows that deviation may a useful indicator of CDH in screening ultrasound examinations. An umbilical vein ratio less than 0.4 is predictive of liver herniation.