A perforated diverticulum of the sigmoid colon found within a strangulated inguinal hernia

We present a rare occurrence of a perforated diverticulum of the sigmoid colon found within the contents of a strangulated left inguinal hernia in a 75-year-old man. The hernia was repaired using the Bassini technique. An end colostomy was established after resection of the diseased section of the sigmoid. We review the relevant literature and discuss the choice of repair techniques in such situations.     

Epiploic appendicitis in inguinal hernia sac presenting an inguinal mass

Inguinal hernia sometimes surprises surgeons with its unexpected content. Epiploic appendagitis in hernia sac is a very rare entity. We report a 60-year-old male patient with a painless inguinal mass. Surgical exploration showed a 4-cm mass beneath the external oblique aponeurosis that consisted of a hernia sac containing an inflamed and remarkably swollen appendix epiploica of the sigmoid colon secondary to torsion. The patient recovered after the resection of epiploic appendix and a tension-free hernia repair.     

Primary omental liposarcoma presenting as an incarcerated inguinal hernia

Herein, we present a case of primary liposarcoma of the omentum found in an incarcerated inguinal hernia in a 52-year-old male patient. The patient was admitted to our hospital in June 2000 with sudden onset of left-sided abdominal and groin pain of 12 hours duration with a large, irreducible inguinal hernia. This was not associated with nausea or vomiting. An emergency operation was performed, and in the hernia sac the tumor, arising from the greater omentum, was found. After we opened the transversal fascia and peritoneum, the tumor was resected with a block of the greater omentum, and hernioplasty was performed using Shouldices method. The histopathological diagnosis of resected tumor showed myxoid type liposarcoma. In the English medical literature, omental liposarcoma has never before been reported as the content of a hernia sac.     

A case of giant inguinal hernia with intestinal malrotation

INTRODUCTIONGiant inguinal hernia is uncommon nowadays.PRESENTATION OF CASEA 75-year-old man with schizophrenia presented with complaints of episodic abdomen pain and constipation accompanied by a huge right scrotal mass. Physical examination revealed a large, irreducible, non-tender right inguinoscrotal hernia. The hernial mass was about 30 cm and extended to the midpoint of the inner thigh. At laparotomy, the intestine from the proximal transverse colon to the terminal ileum with mesentery was found to have herniated through the right inguinal tract without evidence of ischemia or strangulation. The ascending colon showed no adherence to the retroperitoneum and the third and fourth parts of the duodenum descended vertically without Treitz's ligament. The inguinal defect was closed without complications. Ladd's procedure and appendectomy were performed simultaneously.DISCUSSIONSeveral techniques such as distending the abdominal wall progressively or debulking the abdominal contents have been reported. However, no consensus has been reached on a standard surgical procedure for the management of giant inguinoscrotal hernias.CONCLUSIONThis was the first reported case of giant inguinal hernia containing malrotated intestine.     

A case of a large retroperitoneal liposarcoma presenting as an incarcerated inguinal hernia

We report a rare case of retroperitoneal liposarcoma developing within an incarcerated inguinal hernia. A 53-year-old man presented to our hospital with left inguinal mass. Preoperative computed tomography revealed an intraabdominal huge mass, and a clinical diagnosis of liposarcoma. Physical findings except for the inguinal mass and laboratory examination, including tumor markers (CEA, CA19-9), were within normal range. Intraoperatively, the mass was incarcerated in the inguinal canal and involved the left testis. We performed a radical tumor resection, including a left orchiectomy. The resected specimen measured 45 × 30 cm and weighed 7,510 g. Histopathologically, the tumor was diagnosed as a well-differentiated liposarcoma, and originated from retroperitoneum. We did not undergo adjuvant therapy in consideration of histopathological subtype and curable surgical treatment. The patient is well and shows no evidence of recurrence four months after the operation.     

An unusual case of a strangulated right inguinal hernia containing the sigmoid colon

The strangulated inguinal hernia is one of the most common emergencies in surgery. Although the diagnosis is usually made by physical examination, the content of the hernia sac and the extent of the following operation may vary. We present an extremely rare case of a strangulated right inguinal hernia containing the sigmoid colon and review the relevant literature.     

Handlebar hernia masquerading as an inguinal haematoma

We report a child who sustained a traumatic hernia of the lower abdominal wall after being thrown forward against the handlebar of his bicycle. This is a rare injury in children, and the clinical features mimic an inguinal haematoma. Suspicion should be raised by the immediate appearance of a mass above the inguinal canal following groin injury, particularly if the swelling then disappears with the patient supine. Electronic Publication     

Small bowel perforation due to blunt trauma directly to the inguinal region: A case report

We report on a patient with intestinal perforation caused by direct blunt trauma to the inguinal region. The patient had been previously diagnosed with an inguinal hernia. The perforation was managed surgically, and he subsequently underwent hernia repair. In our opinion, intestinal perforation caused by inguinal region trauma in patients with inguinal hernias is a rare and unfortunate situation but one that reveals the importance of inguinal hernia repair.     

The government and the inguinal hernia.

Our review of the incidence of inguinal hernias in children based on socioeconomic differences and their risk of incarceration with its subsequent complications, was prompted by a governmental decision to disallow elective herniorrhaphy in children over 1 yr of age. The review showed the following: The risk of incarceration, the failure of preoperative reduction and the potential gonadal injury is more than three times as high in the poor child, usually covered by Medicaid. Since operative and postoperative complications increase proportional to the incidence of incarcertain, the denial of an elective herniorrhaphy endangers the life of a child. Since the increased hospitalization after incarceration also increases the financial expenditure, this rule is not only medically but also economically unsound. This review suggests that unilateral governmental health care decisions, especially those aimed at cost containment, should be carefully scrutinized to determine what price not only the society, but the patient has to pay for the "cost containment". We feel that the price of the denial of a herniorrhaphy is too high.     

Intrasaccular caecal adenocarcinoma presenting as enlarging right inguinoscrotal hernia

INTRODUCTION

Colorectal cancer and inguinal hernias are both common surgical pathologies in the elderly but rarely co-exist. Where the conditions overlap, there can be difficulties in both diagnosis and treatment.

PRESENTATION OF CASE

A 78 year old man with unexplained iron deficiency anaemia was investigated for gastrointestinal cancer. He was found to have enlarging bilateral inguinoscrotal hernias. CT colonoscopy revealed a herniated caecal carcinoma contained within the scrotum. An open excision was performed.

DISCUSSION

Iron deficiency anaemia without obvious bleeding is associated with colorectal cancer and should be thoroughly investigated. Asymptomatic inguinal hernias are often ignored by patients. However, a change in an existing hernia may be associated with neoplasia.

CONCLUSION

Dual pathology raises new difficulties in assessment, investigation and management of colorectal cancer.     

Peritoneal mesothelioma masquerading as an inguinal hernia

We report a case of an 80-year-old man who presented with a right inguinal hernia that appeared incarcerated. On exploration a sausage shaped mass was found in the sac, which was debulked and histologically shown to be a well differentiated malignant peritoneal mesothelioma. Rare tumours may present as inguinal hernias and palliative debulking may be effective when they present in inguinal hernia sacs.     

Perforated Carcinoma of the Sigmoid Colon in an Incarcerated Inguinal Hernia: Report of a Case

Perforation of the large bowel due to benign or malignant disease in an inguinal hernia is very rare, but should be considered as a potential cause of strangulated hernias. A 79-year-old man with a 2-day history of scrotal swelling and pain in the left side associated with fever and chills was brought to our Emergency Department, where he was classified as American Society of Anesthesiologists IVE. A large left incarcerated scrotal hernia was diagnosed and surgical exploration was performed using local infiltration anesthesia. A standard oblique inguinal incision was made, revealing perforation of the sigmoid colon due to cancer. A 40-cm segmental resection of the sigmoid colon was done, and a double-barrel colostomy was made through the inguinal incision. This surgical strategy involving construction of a double-barrel colostomy through the inguinal hernia incision could be an alternative method of managing such critically ill patients.     

Endometriosis in an inguinal hernia

Summary Endometriosis is a common gynaecological condition characterised by the presence and proliferation of ectopic endometrial tissue. A wide variety of sites have been reported but endometriosis within the inguinal canal is uncommon [Clausen 1987]. The majority of reported cases have described the endometrial tissue as lying in the extraperitoneal portion of the round ligament or within an inguinal lymph node [Clausen 1987]. We report a rare case of endometriosis presenting within the sac of an indirect inguinal hernia.     

Perforated caecal diverticulum as a content of inguinal hernia — report of a rare case

A tablet induced perforation of a caecal diverticulum into a hernial sac is a rare happening. The report discusses the presentation and outcome of a patient with such an unusual disease. A 55-year-old man presented with features of irreducible right sided indirect inguinal hernia. A hard swelling near upper pole of right testis was noted. Scrotal ultrasound revealed a normal testis. At operation caecum and proximal ascending colon were found in the hernial sac with the caecum adherent to the testis. As caecal malignancy could not be ruled out and enbloc Rt Haemicolectomy with Rt orchidectomy was performed. The patient had an uneventful recovery. Pathological examination of the specimen revealed a perforated caecal diverticulum with presence of multiple tablets in its lumen invaginating the upper pole of right testis without any evidence of malignancy. Tablet induced perforation of a caecal diverticulum into a hernial sac is a rare clinical entity. If malignancy cannot be negated at operation, a right haemicolectomy is a safe and feasible option.     

Obstruction of an ileal urinary conduit in an incarcerated right inguinal hernia

We present the case of a 72-year-old man with a history of anuria from his ileal conduit 15 months following its formation. That conduit had become incarcerated in a right-sided ingunial hernia. The patient presented with anuria and an acute kidney injury. A clincal diagnosis of an incarcerated hernia was made, and he was taken to theatre for reduction and repair of the hernia. On removal of the conduit from the hernial sac, it began to drain immediately. He made a full recovery, with normalisation of his renal function.     

腹腔镜下切口疝补片修补并乙状结肠造瘘还纳术三例

目的外伤或医源性损伤造成的直肠或乙状结肠穿孔需急诊行乙状结肠造瘘手术,而术后常出现切口感染直至后期的切口疝,探讨如何以最小的创伤同时处理切口疝并还纳造瘘口。 方法2012年1月至2016年7月鞍钢集团总医院收治了3例腹壁切口疝并需还纳乙状结肠造瘘口患者,对其临床资料进行回顾性分析。 结果3例患者均成功完成腹腔镜下操作,无中转,手术时间150～210 min,平均170 min;术中出血量20～70 ml,术后8～10 d后出院,腹壁造瘘处切口及Trocar孔均一期愈合,无吻合口漏、腹腔感染、血清肿等并发症发生。出院后随访6～48个月,无肠漏、再手术取出补片、疝复发等并发症出现。 结论对于乙状结肠造瘘口还纳加疝修补是可行的,但需做到科学的选择补片,精细的术中操作,严密的围手术期管理。     

Bilateral megaureters presenting as an inguinal hernia

A 4-week-old male presented with a swelling in the right groin. At herniotomy a megaureter was discovered and a subsequent IVU demonstrated bilateral megaureters.     

A hernia in the inguinal region is not always an inguinal hernia

A male patient of 60 years presented with a swelling in the left groin of 10 months duration. Past records showed bilateral lumbar sympathectomy and omentopexy done 20 and 6 years back, respectively, for Buerger’s disease. Abdominal examination revealed a huge hernial swelling in the left groin extending from the symphysis pubis to anterior superior iliac spine measuring 25 × 18 cm. On exploration, the contents were intestines and omentum, which were coming out through a defect of 5 × 3 cm in the lower fibers of the conjoint muscle 4 cm cephalad to the deep ring, a finding which made the final diagnosis as an incisional hernia. We present this interesting case as a very rare complication of omentopexy, probably not reported previously, and an unusual case of an incisional hernia presenting as an inguinal hernia which is very difficult to diagnose unless encountered before. Its rarity and clinical challenge is highlighted.     

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目的探讨无张力疝修补术在腹股沟复发疝中的临床应用价值。方法自2000年8月至2003年5月应用无张力疝修补术治疗腹股沟复发疝病人52例,其中应用疝环填充法38例,三合一补片法14例,观察手术时间、伤口疼痛、术后自主功能的恢复、并发症及复发率。结果手术全部成功完成,平均手术时间50min,术后4例出现尿潴留,5例出现阴囊积液。术后5～7d出院,随访3～36个月未见复发病例。结论无张力疝修补术是治疗腹股沟复发疝的理想术式,具有手术安全、创伤小、痛苦小、术后恢复快、近期疗效满意和复发率低等优点,手术方式应“个体化”。     

传统与无张力腹股沟疝修补术疗效对比

目的探讨无张力疝修补术在腹股沟疝中的应用价值及疗效观察。方法共有106例腹股沟疝患者,随机分成传统组和无张力组,比较2组的疗效。结果采用无张力疝修补术治疗腹股沟疝在手术时间、住院时间、以及切口疼痛等方面优于传统腹股沟疝修补术。结论无张力疝修补术可以安全、有效地应用于临床。