Bilateral round ligament varicosities mimicking inguinal hernia during pregnancy

Round ligament varicosities during pregnancy have not been reported extensively. The swelling mimics an inguinal hernia and should be considered in the differential diagnosis of a groin swelling during pregnancy. We report a case of a pregnant woman with bilateral round ligament varicosities. At 22 weeks of pregnancy she was operated on based on the clinical suspicion of a painful inguinal hernia on the right side. Surgical exploration revealed varicosities of the round ligament, and resection was performed. Four weeks later the same diagnosis was made by duplex sonography of a painful swelling in the left groin. Increased pain necessitated surgical exploration and resection of the varicosities on the left side. The postoperative course on both sides was uneventful and without pain during the rest of her pregnancy, during labor or post partum. An erratum to this article can be found at     

腹腔镜修补成年女性腹股沟疝的临床研究

目的探讨女性腹股沟疝的特殊性及腹腔镜下修补的临床疗效。方法回顾性分析2009年5月至2013年3月苏州大学附属第二医院普外科41例成年女性腹股沟疝腹腔镜下修补的临床资料。结果4l例（46侧）均在腹腔镜下顺利完成腹股沟疝修补术,其中完全腹膜外修补术（totallyextraperitoneal,TEP）28例（32侧）,经腹腹膜前修补术（transabdominalpreperitoneal,TAPP）11例（12侧）,腹腔内修补术（intraperitonealonlaymesh,IPOM）2例（2侧）。术中发现股疝误诊为腹股沟斜疝2例;3例术前诊断为单侧疝,术中发现对侧隐匿疝;2例患者术中发现合并子宫圆韧带囊肿,术后发生血清肿6例（14．6％）;修补区域异物感4例（9．8％）;术后急性疼痛5例（12．2％）,4例3～6周后基本缓解,1例持续疼痛2个月以上,无腹腔脏器损伤、术后出血、感染、术后尿潴留等并发症的发生,所有患者4周内基本恢复非限制性活动,随访期间各修补方式患者均无复发。结论腹腔镜下女性腹股沟疝修补方式覆盖了整个薄弱的耻骨肌孔区域,可以有效的防止女性腹股沟区继发疝的发生,并且具有创伤小、恢复快、美观等优点,术中子宫圆韧带连续性应尽量予以保留,有利于将来女性患者的生活。     

Round ligament varicosities diagnosed as inguinal hernia during pregnancy: A case report and series from two regional hospitals in Japan

IntroductionRound ligament varicosities (RLV) are not well-known and they are usually caused by pregnancy. Although the groin swelling of RLV mimics an inguinal hernia, it is difficult to distinguish between them through clinical examination alone, and there have been few published reports on this topic, especially from Asia.Case presentationA 37-year-old Japanese woman complained of left groin swelling for 2 weeks at her 28th week of gestation of her first pregnancy. According to a physical examination, she had a soft, painless swelling in the superficial inguinal ring of the left groin. An inguinal hernia was suspected and she was thus scheduled to undergo herniorrhaphy. However, since she had varicosities in the left labia majora, she first underwent color Doppler ultrasonography and a final diagnosis of round ligament varicosities was this made. Her symptoms resolved after delivery of her baby.DiscussionWe herein report 10 cases of RLV in pregnant Japanese women who were initially suspected of having an inguinal hernia. All of them were suspected to suffer from inguinal hernias after a clinical examination by their attending gynecologist. All of them were diagnosed using gray scale and color Doppler ultrasonography, treated with conservative management, and the symptoms resolved in all cases after the delivery.ConclusionThis is the largest report from Asia regarding RLV. To avoid unnecessary surgery in pregnant women, surgeons must be aware of this entity make an accurate diagnosis based of the findings of Doppler ultrasonography.     

Inguinal endometriosis or irreducible hernia? A difficult preoperative diagnosis

Two cases of endometriosis infiltrating the round ligament and associated with an inguinal hernia are presented. The initial diagnosis was irrducible hernia, since this rare association often causes unusual preoperative symptoms and diagnostic problems. Diagnosis is frequently made by histologic examination. Surgery is the treatment of choice both for hernia and for endometriosis, and is locally curative. However, in a fertile women with a painful mass in the inguinal region the possibility of endometriosis should be considered, and if suspected at inguinal exploration a laparoscopy should be made to rule out the presence of intraperitoneal endometriosis.     

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.     

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.     

Autologous reconstruction of the inguinal ligament using pedicled fascia lata flap: A new technique

INTRODUCTIONA technique of reconstructing the inguinal ligament using a pedicled fascia lata flap is described.PRESENTATION OF CASEA 62-year-old man was referred with massive bilateral abdominal wall hernias, following numerous attempts at repair and subsequent recurrences. There was complete absence of the right inguinal ligament.The inguinal ligament was reconstructed using a strip of fascia lata, pedicled on the anterior superior iliac spine. This was transposed to cover the external iliac vessels, and sutured to the pubic tubercle. The musculoaponeurotic abdominal wall was reconstructed with two 20 cm × 20 cm sheets of porcine acellular dermal matrix and an overlying sheet of polypropylene mesh, sutured to the remaining abdominal wall muscles laterally, and to both inguinal ligaments. The cutaneous abdominal wall was closed with an abdominoplasty technique.The reconstruction has remained intact nine months following surgery.DISCUSSIONComplete destruction of the inguinal ligament is rare but can occur following multiple operative procedures or trauma. To date, the only published reports of inguinal ligament reconstruction have been performed using synthetic mesh. The use of autologous tissue should reduce the risk of erosion into the neurovascular bundle, seroma formation, and enhance integration into surrounding tissues.CONCLUSIONThis new technique for autologous reconstruction of the inguinal ligament provides a safe alternative to the use of synthetic mesh in the operative armamentarium of plastic and hernia surgeons.     

Pelvic leiomyoma presenting as perineal hernia

Primary perineal hernias are rare and can be a diagnostic challenge. We report the case of a 45-year-old female patient who presented with painless perineal swelling suggestive of perineal hernia. Computed tomography (CT) scanning revealed a pelvic mass herniating through the pelvic floor into the perineum. The lesion was completely excised by an abdominoperineal approach. Histopathological examination of the lesion revealed a leiomyoma. This case report suggests that the possibility of perineal herniation of a pelvic leiomyoma should be considered in a female patient with suspected primary perineal hernia. We recommend an abdominoperineal approach for the surgical management of such a lesion.     

Mesothelial cyst presenting as an irreducible inguinal mass

Inguinal hernias are common in the pediatric population. We describe a 10-year-old child who presented with signs and symptoms suggestive of an incarcerated inguinal hernia. Ultrasound examination demonstrated an aperistaltic multicystic inguinal mass of uncertain origin. The mass was resected, and the adjacent hernia was repaired. Histologic examination identified the mass as a mesothelial cyst. Mesothelial cysts are rare groin lesions in children that can masquerade as an incarcerated inguinal hernia in a child.     

Leiomyosarcoma of the inguinal canal

We describe a rare case of a leiomyosarcoma in the inguinal canal in a patient presenting clinically with an inguinal hernia. The clinical details, histological findings and surgical management are reviewed.     

疝环充填式无张力疝修补术治疗腹股沟疝(附246例报告)

目的 探讨疝环充填式无张力疝修补术治疗腹股沟疝的可行性。方法 使用美国巴德公司生产的锥型充填物及成型补片(Mesh Plug and Patch)施行疝环充填式无张力修补246例腹股沟疝。结果 手术时间20min-60min，平均45min。无1例使用镇痛药物，切口疼痛时间2天～3天。术后3h-6h病人能下床活动。术后发生并发症9例，(0．04％)，无1例发生心、肺、脑并发症，无1例切口感染。全部病人随访1月～21月，无复发。结论 疝环充填式无张力疝修补术治疗腹股沟疝可行，其手术指征宽，操作简单，创伤小，恢复快，并发症少和复发率低。     

Evaluation of inguinal hernia in ambulatory surgery: A prospective monocentric study on 1009 inguinal hernia

Ambulatory surgery for inguinal hernia has not been really developed in our country.

Aim

We evaluated the feasibility of inguinal hernia surgery on ambulatory.

Patients and methods

From January 1995 to June 2004, we performed 1009 inguinal hernia. There were 934 men (92.8%) and 75 women (7.2%). Middle age was 58.36 years (range: 7–95 years). All the patients were examined by their primary doctor on the first and the third day and by the surgeon on the tenth day after discharge. Telephone follow-up on the patient's condition was performed by a registered nurse on postoperative days 1 and 3.

Results

Eight hundred and thirty three patients were operated on by ambulatory surgery (82.5%). Overall morbidity was 8.5% (n = 86). Satisfaction index was excellent for 93.8% (n = 948). Locoregional anesthesia alone or associated with general anesthesia was used for 900 patients (98.1%). Only 466 patients (46.2%) were painful, 258 (25.55%) had a discomfort, and 285 (28.24%) had no symptomatology.

Conclusion

Tension-free technique under locoregional anesthesia for inguinal hernia allows ambulatory surgery with a low rate of morbidity and high satisfaction index.     

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.     

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.     

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.     

Direct inguinal hernia containing bladder carcinoma: A case report and review of the literature

INTRODUCTION

Inguinal hernia containing bladder carcinoma is a very rare occurrence.

PRESENTATION OF CASE

We report a case of a male patient who presented with a left groin hernia containing an irregular mass. The hernia was repaired without the use of mesh and a partial cystectomy was done.

DISCUSSION

Only 1–3% of all inguinal hernias involve the bladder, with very few reports containing a carcinoma.

CONCLUSION

Treatment consists of removing the tumor and repairing the hernia.     

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。