Dermoid cyst of the spermatic cord in children

Most of inguinal masses in children correspond to inguinal indirect hernias, but other pathologic entities may be found. Dermoid cysts of the spermatic cord are very rare, with only 9 clear cases reported in the literature to date, all of them in adults. We present a case of dermoid cyst of the spermatic cord in a 2-year-old boy, the youngest patient reported so far. Dermoid cysts of the spermatic cord should be considered as part of the differential diagnosis of inguinal masses in children, especially in cases of long-standing, nontender, and irreducible inguinal mass.     

Laparoscopic resection of a retroperitoneal myolipoma presenting in a right inguinal hernia

INTRODUCTIONMyolipoma of soft tissue is an extremely rare benign lipomatous lesion. The lesions are most commonly located in the abdominal cavity, retroperitoneum, and inguinal areas. Despite their large size, myolipomas are cured by surgical resection.PRESENTATION OF CASEWe present the case of a 79 year-old man who presented with bilateral reducible inguinal hernias (right larger than left). After reducing the right inguinal hernia (RIH), the sensation of a palpable mass was noted in the right iliac fossa. CT scan suggested the content of the right inguinal hernia (RIH) to be small bowel mesentery and no other mass was noted in the right iliac fossa (possibly missed on CT scan).DISCUSSIONA very large 1.8 kg retroperitoneal lipomatous lesion, measuring 22 cm × 16 cm × 8 cm, attached to the right spermatic cord was found and excised laparoscopically during a trans-abdominal pre-peritoneal (TAPP) approach to repair the hernias. The lesion was pathologically defined as a myolipoma.CONCLUSIONThe laparoscopic TAPP approach to repair inguinal hernias allows the surgeon to inspect the peritoneal cavity, and in this case it was possible to safely dissect and remove a large, lipomatous, retroperitoneal lesion laparoscopically. To the best of our knowledge, there are no reports of local recurrence, metastatic disease, or malignant transformation of myolipomas, and the laparoscopic approach to resect such a lesion has not been reported.     

A Dermoid Cyst of the Round Ligament Clinically Misdiagnosed as Incarcerated Inguinal Hernia

We present a case of a dermoid cyst located in the round ligament in a patient with a preliminary diagnosis of inguinal hernia. The dermoid cyst was diagnosed based on MRI findings and confirmed histopathologically. Dermoid cyst (mature teratoma) is a congenital cystic tumour formed by the well-developed (mature) tissues of at least two of the three germinal layers. It is mainly encountered in the gonads. Location within the round ligament is quite rare. Due to the anatomical localization of the round ligament, dermoid cysts within it or other inguinal canal masses are usually misdiagnosed as inguinal hernia. However, when an inguinal canal mass is encountered, despite the higher hernia frequency, a proper suspicion and investigation with regard to masses in this area could be extremely important in preventing intraoperative surprises.     

Duplicated vas deferens: A case report and comprehensive review of the literature

Duplication of vas deferens is a very rare anomaly which two vasa deferentia are found in the spermatic cord. It can be recognised during autopsy or cadaveric dissection and also several surgical procedures which require spermatic cord dissection including inguinal hernia repair, orchiopexy, vasectomy, varicocelectomy, vasectomy reversal and radical prostatectomy. Recognition of the duplicated vas deferens is important to avoid surgical complications such as an unsuccessful vasectomy or transection of the vas. It was reported in only three cadavers and 31 patients since 1959. In this study, we describe a new case of duplicated vas deferens found incidentally during routine inguinal hernia repair in a 66-year-old patient. We also review all previously reported cases in the literature to draw attention to this rare but important anomaly.     

Dermoid cyst of the spermatic cord: a rare cause of benign inguinal lump

Dermoid cyst of the spermatic cord is an extremely rare pathology seen at the urological clinic. We present the case of a 26-year-old man who presented with a groin lump, thought to be a lipoma or a hydrocoele of the cord. The final histopathological analysis established the diagnosis of a dermoid cyst.     

Large foreign body reaction to tension-free vaginal tape masquerading as inguinal hernia

We report a case of a 73-year-old woman who presented to general surgery with a tender lump in the groin 5 years after insertion of a tension-free vaginal tape. The lesion was thought to be an incarcerated inguinal hernia. Emergency surgical exploration revealed a 7 × 5 × 4 cm soft tissue mass which was adherent to the external inguinal ring, emanating from the end of the tension-free vaginal tape at the level of the symphysis pubis. Resection and histological examination revealed a central track of granulation tissue with a surrounding foreign body inflammatory response. The surgery was complicated by an infected seroma requiring surgical drainage and antibiotic therapy, following which the patient made a full recovery. Large foreign body reaction is a rare but an important complication of tension-free vaginal tapes and may be mistaken for a groin hernia or lymphadenopathy.     

A method for the reduction of chronic pain after tension-free repair of inguinal hernia: iliohypogastric neurectomy and subcutaneous transposition of the spermatic cord

Purpose  

We assessed the efficacy of iliohypogastric neurectomy and subcutaneous transposition of the spermatic cord and ilioinguinal and genital nerves on the incidence of postoperative chronic pain (PCP) after open inguinal hernia repair with polypropylene mesh.     

Transcutaneous laparoscopic hernia repair in children: a prospective review of 275 hernia repairs with minimum 2-year follow-up

Background  Inguinal hernia in children is traditionally repaired through a groin incision by dissecting the hernia sac from the spermatic cord and suture ligating its base. A laparoscopic modification of this procedure involves placement of a transcutaneous suture around the neck of the sac through a 2-mm stab incision under visualization with an umbilically placed 2.7-mm 30^o lens. We reviewed the clinical outcome of this novel procedure at our institution. Methods  Prospective review of 275 hernias in 187 children (144 male, 43 female) performed laparoscopically by a single surgeon between September, 2002 and June, 2005. Data analyzed included side of hernia, incarceration, prematurity, recurrence rate, and complications. Results  30 left, 69 right, and 25 bilateral hernias were repaired. Sixty-three unilateral hernias had a contralateral patent processus vaginalis that was repaired. Mean operative time for a bilateral repair was 17 min. Two procedures were for recurrence after open repair. Forty-nine patients were ex-premature infants, accounting for 79 repairs. Fifteen cases followed reduction of incarcerated hernias, nine of whom were in preterm infants. Four out of 275 hernias (1.5%) recurred in four patients (mean age 4.5 years; 3 male, 1 female). There were four superficial wound infections, two umbilical granulomas, two hydroceles, and six self-resolving hematomas. There were no spermatic cord injuries, testicular atrophy, or symptoms of ilioinguinal nerve injuries. Conclusion  This novel laparoscopic inguinal hernia repair is an effective method in children, with recurrence rates comparable to the traditional approach. Advantages of the laparoscopic operation include a “no-touch” approach to the spermatic cord structures, a virtually virgin operative field in cases of recurrence, and excellent cosmesis. Disadvantages include peritoneal access and nonhermetic seal in males.     

Unreported location and presentation for a parasitic ovarian dermoid cyst in an indirect inguinal hernia

Extragonadal mature cystic teratomas (dermoid cysts) have been reported occasionally, with the most common site being the omentum. We report a rare case of a parasitic dermoid cyst that was incidentally found in an indirect inguinal hernia sac in a 66-year-old woman. The right ovary was absent from its proper anatomical location. Histopathologic study revealed a mature cystic teratoma with viable ovarian tissue. These findings suggested auto-amputation of the ovary either by inflammation or torsion.     

Inguinal hernia of seminal vesicle cyst

Seminal vesicle cysts are uncommon abnormalities in the pelvis. The case of a seminal vesicle cyst that extended through the inguinal canal is reported. A 35-year-old man presented with left inguinal swelling. He was diagnosed with a left inguinal hernia. However, the interpretative diagnosis was a spermatic cord tumor. The operation was changed to tumor resection. The tumor existed along with the vas deferens from part of the parietal peritoneum outside the inguinal tunnel to the deep pelvic space. The cylinder-shaped tumor was 3 cm in diameter and 20 cm long. Pathological examination revealed a seminal vesicle cyst that extended through the inguinal canal. To the best of our knowledge, this is the first case report of a seminal vesicle cyst inguinal hernia.     

Cremasteric muscle hypertrophy accompanies inguinal hernias in children.

PURPOSE: The physical finding of a thickened spermatic cord as indicator of an inguinal hernia in children is well documented. This thickening has been attributed to the presence of a hernia sac. Based on our clinical observations, cremasteric fibers appeared thickened in the presence of an inguinal hernia. The authors postulated that hypertrophy of cremasteric fibers contributed to the physical finding of cord thickening. METHODS: The authors evaluated 18 patients ages 5 months to 9 years, 17 boys and one girl. Each patient was found to have a unilateral inguinal hernia with palpable thickened cord on the affected side. The contralateral side contained no detectable hernia or palpable cord thickening. Each patient underwent repair of the clinical hernia and exploration of the contralateral groin. Cremasteric fiber biopsy sections were taken from both sides for cross-sectional measurement and comparison. The biopsy specimens were evaluated by a pathologist unaware of the hypothesis. RESULTS: In 15 of 18 patients microscopic measurement of the cremasteric fibers showed hypertrophy on the side of the clinical hernia when compared with the contralateral side. The contralateral side was found to have either no hernia or a small patent or obliterated processus vaginalis. CONCLUSION: The authors conclude that the palpable thickening of the spermatic cord, the "silk glove sign," in most cases is caused not only by an empty hernia sac but also by hypertrophied cremasteric muscle fibers.     

Sperm granuloma of the inguinal vas deferens mimicking recurrent incarcerated inguinal hernia

Masses of the spermatic cord are rare and can be neoplastic or inflammatory lesions. We present a case of a sperm granuloma of the inguinal vas deferens presenting as a recurrent incarcerated inguinal hernia in a 42-year-old man.     

Leiomyomas of spermatic cord and testis presenting as hernia--chromosomal analysis

We report a rare case of three leiomyomas of the permatic cord and testis in a 73-year-old man. Indirect, large, painful, non-reducible inguinal hernia was diagnosed at admission. During surgery, the hernia was revealed. Furthermore, two tumors were found, both attached on the spermatic cord, and a third tumor close to the testis. All the tumors were carefully removed and no orchidectomy was performed. Hernia repair was performed and the removed tumors were sent to the Pathology Department. All tumors were benign. At the first follow up, chromosomal analysis was also performed. Chromosomal lymphocyte analysis revealed increased fragility at site 4q31. Two years after surgery, the patient was admitted again with a new similar tumor, and underwent a new surgical treatment. In the case of large non-reducible inguinal hernias, surgeons have to consider tumors in the inguinal area in their differential diagnosis.     

Epidermoid cyst arising from the spermatic cord area

PURPOSE: We report on an epidermoid cyst arising from the spermatic cord area that was confirmed histologically after local excision. METHODS/RESULTS: Radiologic studies demonstrated a well-encapsulated solid mass in the left inguinal region, which was adjacent to the left spermatic cord. Tumor resection was then performed. Pathological examination revealed a epidermoid cyst lined with keratinized squamous epithelium. CONCLUSION: There was no recurrence observed 5 years after surgery.     

腹股沟疝无张力修补术对男性生殖功能的影响

通过回顾腹股沟疝的流行病学,以及腹股沟疝无张力修补术中补片对精索、精索血管、输精管和睾丸影响的研究,总结临床及动物实验中腹股沟疝修补术本身及疝补片对男性生殖功能的影响部位、程度和病理改变,探讨腹股沟疝无张力修补术对男性生殖功能的影响机制,以期通过术式改进、选择更恰当的疝补片降低腹股沟疝无张力修补术对男性生殖功能的影响.     

平片后腰带式固定在腹腔镜完全腹膜外腹股沟疝无张力修补术中的应用

目的:探讨腹腔镜全腹膜外(totally extraperitoneal,TEP)腹股沟疝无张力修补术术中固定平补片的实用性及要点。方法:2012年1月至2016年11月收治102例患者,腹股沟斜疝、直疝及股疝共108侧。TEP术中建立10 mm观察孔、2个(或3个)5 mm Trocar操作孔,将平片修剪为近椭圆形11 cm×15 cm,作为主作用平片;修剪1.2 cm×4~8 cm小片条,作为辅助固定平片。小片条后腰带式方法呈"V"形固定同侧输精管、精索或子宫圆韧带。结果:99例采用两孔法完成手术,3例采用三孔法,无一例中转开放手术。Ⅲ型疝中6例巨大腹股沟疝(外环口大于3指),术中于外环口水平做2 cm横切口,直视下间断缝闭数针,以缩小外环口。术中4例患者出血超过50 ml;2例患者于肌耻骨孔区放置引流管;无肠管、膀胱损伤及大片皮下气肿(面积>15 cm×15 cm)发生。术后第1天可下床活动,3~7 d出院,平均(3.6±1.2)d。术后4例患者发生7 cm×6 cm×5 cm以上阴囊肿,经抬高阴囊、卧床休息后15~35 d自愈。未发生与本次疝手术相关的再手术,1例患者术后一年出现对侧新发疝。结论:TEP术中利用人体自有韧性组织固定主平片,位移小;经修剪的小片条后腰带式固定主平片,固定方法简单实用、效果可靠,覆盖疝内环口理想,具有一定的临床应用价值。     

Liposarcoma of the spermatic cord masquerading as an incarcerated inguinal hernia

We present a rare case of liposarcoma of the spermatic cord. There are only 61 reports in the literature. The presenting complaint is usually a painless bulge in the inguinal or scrotal region. Our patient presented with a new-onset inguinoscrotal swelling that was misdiagnosed preoperatively as an incarcerated indirect hernia. The treatment for a spermatic cord liposarcoma is radical orchiectomy with high ligation of the cord. Radiation therapy is recommended in addition to surgery in situations with evidence of tumor with propensity for more aggressive behavior (i.e., high-grade tumor, lymphatic invasion, inadequate margin, or recurrence). The current literature, diagnosis, and management of malignant tumors of the spermatic cord are reviewed.     

Intraoperative Varicocele Anatomy: A Microscopic Study of the Inguinal Versus Subinguinal Approach

PurposeThe groin approach to varicocelectomy is performed by an inguinal (aponeurosis of external oblique opened) or subinguinal (external oblique aponeurosis intact) technique. We describe the number and relationship of internal and external spermatic arteries, veins and lymphatics within the subinguinal portion of the spermatic cord in infertile men undergoing microscopic varicocelectomy and compare these findings to the microanatomy observed with the inguinal approach.Materials and MethodsA total of 48 consecutive patients underwent 84 microsurgical subinguinal varicocelectomies during which the detailed intraoperative microanatomy of the spermatic cord and gubernacula was recorded. These observations were compared with a previously reported group of 83 consecutive patients that underwent 115 inguinal varicocelectomies. Subinguinal microscopic findings were also evaluated relative to clinical varicocele grade.ResultsThe spermatic cord in the subinguinal dissection was characterized by a smaller number of large (greater than 5 mm) internal spermatic veins and a greater number of small (less than 2 mm) internal spermatic veins than the cord in the inguinal dissection (mean 0.4 vs 1.9 large veins and mean 7.9 vs 4.7 small veins, respectively). The subinguinal dissection was also characterized by a significantly greater percentage of external spermatic veins greater than 2 mm than that observed during inguinal dissection (93% vs 74%, respectively, p <0.05). Multiple spermatic arteries were identified in 75% of subinguinal dissections and in only 31% of inguinal dissections (p <0.03). Internal spermatic arteries were surrounded by a dense complex of adherent veins in 95% of cases using the subinguinal approach, whereas this finding was true in only 30% of cases with the inguinal approach (p <0.001). The clinical grade of a varicocele was significantly associated with the number of internal spermatic veins greater than 2 mm found intraoperatively (p <0.001) but not with the maximum internal spermatic vein diameter.ConclusionsAlthough the subinguinal approach to microsurgical varicocelectomy obviates the need to open the aponeurosis of the external oblique, it is associated with a greater number of internal spermatic veins and arteries compared with the inguinal approach. The primary branch point for the testicular artery occurs most commonly during its course through the inguinal canal. Internal spermatic arteries at the subinguinal level are more than 3 times as likely to be surrounded by a dense network of adherent veins than when they are identified at the inguinal level. Taken together, these data suggest that microscopic dissection is more difficult with a subinguinal incision.     

Myxoid liposarcoma of the spermatic cord: A case report and review of the literature

Myxoid liposarcoma of the spermatic cord (MLSC) is a rare variance of spermatic sarcomas, with only 14 previous cases having been reported. Typically it presents during the seventh decade of life as a painless scrotal or inguinal mass. Although local recurrences are not uncommon, prognosis following complete tumour removal is good because metastases are rare. We describe one new case of a 24-year-old male with incidental MLSC found during inguinal hernia repair, and also review the existing literature.     

开放式前入路腹股沟疝修补术后慢性疼痛的超声诊断

目的分析开放式前入路腹股沟疝修补术后慢性疼痛的超声诊断意义。 方法选取2009年8月至2014年5月,复旦大学附属华东医院164侧因开放式前入路腹股沟疝修补术后持续慢性疼痛病例,通过超声检查明确慢性疼痛的病因,对合并出现的各项病因进行分组比较。 结果超声检查发现引起术后慢性疼痛的阳性诊断有：包裹性积液、阴囊壁水肿、睾丸炎症、睾丸鞘膜腔积液、精索在重建内环口处活动受限、精索静脉曲张、耻骨处瘢痕增生、补片皱缩变形、补片或网塞堆积、复发疝、精索囊肿、附睾头囊肿。在两两合并出现的阳性诊断各组中,包裹性积液合并阴囊壁水肿、精索静脉曲张合并精索在重建内环口处活动受限、补片变形皱缩合并和复发疝的发生率在各自分组内存在显著差异（χ²=41.37、20.07、13.19、7.36,P均<0.05）。 结论超声检查对于开放式前入路腹股沟疝修补术后慢性疼痛的诊断具有重要价值,部分阳性诊断因病程发展常合并出现,临床医师诊断时需全面考虑。