Incarcerated inguinal hernia presenting as spontaneous scrotal fecal fistula

We report a case of neglected, strangulated, inguinal hernia in a middle-aged male, which presented as a scrotal fecal fistula. This is the first such case reported in an adult. The patient was treated by resection and anastamosis of the ileum, local debridement of the scrotum and Shouldice repair for the inguinal defect.     

Concurrent Spigelian hernia and falciform ligament hernia in a 67-year-old female

IntroductionInternal abdominal hernias account for 1% of all hernias but 5.8% of all bowel obstructions and hence are of significant clinical importance. Similarly Spigelian hernias account for only 0.12–2% of all abdominal wall hernias.Case presentationWe present and discuss the management of a case that presented with concurrent falciform ligament internal abdominal hernia and Spigelian hernia. We believe this is the first reported case of such an occurrence in the literature.ConclusionDue to the advancements in computer topography (CT) imaging many internal and Spigelian hernias are diagnosed pre-operatively though these scan are not always available or indicated in cases of suspected small bowel obstruction. Due to the high mortality rate of undiagnosed internal hernias a high clinical suspicion must be maintained. The authors recommend laparoscopic trans-abdominal repair of Spigelian hernias in order to examine the abdominal contents and exclude rare, though potentially serious internal hernias.     

Incarcerated amyand hernia

Amyand’s hernia is a rare condition defined by the inclusion of the appendix vermiformis within the hernia sac. Its incidence among cases of groin hernia is less than 1%. The clinical manifestation of incarcerated inguinal hernia generally masks the symptoms and signs of acute appendicitis, which renders preoperative diagnosis difficult. In this study, we present two cases of Amyand’s hernia that were diagnosed preoperatively. The patients were taken for operation with the prediagnosis of ?ncarcerated inguinal hernia. We evaluated these cases along with data from prior studies.     

Incarcerated small bowel in a spigelian hernia

We report on a case of a 68-year-old man who was transferred to our department to undergo surgical treatment of intestinal obstruction and a palpable right-sided abdominal mass. The abdominal computed tomography scan revealed a small bowel obstruction with an incarcerated spigelian hernia. A mesh repair was performed by suturing the mesh to the internal oblique muscle and to the rectus sheath. The postoperative course was uneventful, and no recurrence has occurred during the 2-year follow-up. An urgent operation should be performed as soon as an accurate diagnosis of incarcerated spigelian hernia has been made. Computed tomography should be helpful in order to establish an accurate diagnosis of the incarcerated hernia.     

Incarcerated inguinal hernia in children

A survey has been made of 110 children under 4 years of age who developed inguinal hernias. Of these, 61 became incarcerated at some time, the highest incidence being in the youngest infants; the bowel was not strangulated in any of these hernias. No untoward effects were seen to result from a short trial of conservative treatment in incarcerated hernia.     

Incarcerated lumbar hernia: a rare presentation

This case illustrates the diagnostic uncertainty seen in lumbar herniation as a rare cause of large bowel obstruction.     

Incarcerated vermiform appendix in a left-sided inguinal hernia

We report here of a patient with an incarcerated vermiform appendix occurring in a left-sided indirect inguinal hernia. Occasionally, appendices are found in a hernial sac; however, the finding of an incarcerated vermiform appendix in an inguinal hernia on the left side is very unusual and has only been previously described once. The patient suffering this rare entity underwent appendectomy and repair of the hernia and experienced an uneventful postoperative recovery. The possibility of the presence of a situs inversus, or malrotation, as an underlying cause for the observed pathology was excluded by x-ray examination.     

Sliding hernia of the bladder presenting as suprapubic pain in a female

We report a case of bilateral sliding hernia of the bladder in a 64-year-old woman who presented with suprapubic pain and nocturia and was diagnosed by voiding diary and cystogram.