scholarly journals Incarcerated femoral hernia treated with elective totally extraperitoneal repair: a case report

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Shigeo Ninomiya ◽  
Syunsuke Fujita ◽  
Tadashi Ogawa ◽  
Yoshitake Ueda ◽  
Norio Shiraishi ◽  
...  
Keyword(s):  
Femoral Hernia ◽  
Elective Surgery ◽  
Lower Abdominal Pain ◽  
Greater Omentum ◽  
Preperitoneal Space ◽  
Hernia Sac ◽  
Totally Extraperitoneal ◽  
The Right ◽  
Totally Extraperitoneal Repair ◽  
Incarcerated Groin Hernia

Abstract Incarcerated groin hernia is a common surgical emergency. However, reports of incarcerated femoral hernia treated with elective totally extraperitoneal repair are extremely rare. A 62-year-old woman visited our hospital with lower abdominal pain and bulging from a right groin lesion. The patient was diagnosed as having right incarcerated femoral hernia containing greater omentum by computed tomography. As there were no clear findings of intestinal obstruction and peritonitis, elective surgery was performed. Intraoperatively, the hernia sac had herniated into the right femoral canal. We could release the hernia sac using laparoscopic forceps. After reduction of the hernia sac, polypropylene mesh was placed in the preperitoneal space and fixed to Cooper’s ligament. The patient’s postoperative course was uneventful, and she was discharged 3 days after surgery. We consider elective totally extraperitoneal repair for incarcerated femoral hernia to be an effective procedure for selected patients who have been diagnosed accurately.

The Comparison of Balloon and Camera Dissection of the Preperitoneal Space in Totally Extraperitoneal Repair Hernia Repair. Our Initial Experience!

2021 ◽  
pp. 155335062199929
Author(s):  
Selim Birol ◽  
Hasan V. Ofluoglu
Keyword(s):  
Hernia Repair ◽  
Operating Time ◽  
Operation Time ◽  
Preperitoneal Space ◽  
Post Discharge ◽  
Hernia Sac ◽  
Totally Extraperitoneal ◽  
Working Space ◽  
Severity Scores ◽  
Totally Extraperitoneal Repair

Purpose. To perform totally extraperitoneal repair of a hernia, it is essential to create a working space for the placement of instruments. In this study, we aimed to compare balloon dissection (BD) and camera or telescopic dissection (CD) with respect to the surgical outcomes, without considering the cost-effectiveness. Methods. Forty consecutive, healthy, unilateral inguinal hernia patients who underwent Totally Extraperitoneal Repair hernia repair were randomized into 2 groups according to whether they received BD or CD. The perioperative demographic characteristics were recorded. All the operations were video recorded from the beginning to the end of each procedure. The virtually constructed periods of the procedures were evaluated by another surgeon who watched each video. The time spent for each period, the severity score assigned by the surgeon, the total operation time, the peritoneal laceration rate, the presence of early and late postoperative pain, the number of postoperative visits, the total analgesic requirements, and the complications were recorded. Results. The demographic properties of the patients, the perioperative and postoperative complications, and the severity scores in the BD and CD groups were statistically similar. The total operating time and the time from the dissection of the peritoneum to the reduction of the hernia sac were significantly longer in the CD group. Post-discharge analgesic consumption, Visual Analog Scale scores, and the number of visits were similar between the groups. Conclusions. The dissection of the working space in the preperitoneal area can be achieved using camera dissection without the risk of common complications associated with balloon dissection, particularly balloon rupture.

scholarly journals Usefulness of a Long Forceps Technique in Single-Incision Laparoscopic Surgery for Totally Extraperitoneal Repair of Inguinal Hernia

2017 ◽  
Vol 102 (3-4) ◽  
pp. 115-118
Author(s):  
Yutaka Tokairin ◽  
Yasuaki Nakajima ◽  
Kenro Kawada ◽  
Akihiro Hoshino ◽  
Kagami Nagai ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Laparoscopic Surgery ◽  
Single Incision ◽  
Preperitoneal Space ◽  
Single Incision Laparoscopic Surgery ◽  
Hernia Sac ◽  
Co2 Gas ◽  
Umbilical Incision ◽  
Totally Extraperitoneal ◽  
Totally Extraperitoneal Repair

Collisions between the laparoscope and the forceps remain a specific problem for single-incision laparoscopic surgery (SILS). We considered that the use of a long forceps would resolve this problem and use the long forceps in SILS for totally extraperitoneal repair (TEP). SILS for TEP (S-TEP) was performed to treat 34 inguinal hernias in 27 patients from November 2013 to February 2015. Among them, unilateral inguinal hernia repair was performed in 5 patients (median age: 71 years; range: 40–88 years) using a laparosonic coagulating shears (LCS) device and a straight long (43 cm) forceps. A 1-cm umbilical incision was made, a 5-mm flexible laparoscope was moved into the peritoneal cavity, and the type of inguinal hernia was diagnosed. Next, preperitoneal space was made using a finger or gauze. The single-port device was applied at preperitoneal space and insufflation was initiated with CO2 gas. The preperitoneal space was more easily created using a long straight forceps rather than standard ones. The hernia sac was then freed from the spermatic cord and a mesh was rolled, inserted, and deployed. Absorbable spiral tackers were used for fixation over the Cooper's ligament, lateral to the inferior epigastric vessels. The use of a long forceps was considered to be associated with reduction of the difficulty for dissection in S-TEP. We considered the use of a long forceps to be useful to the S-TEP operation.

Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain

2021 ◽  
Vol 14 (1) ◽  
pp. e232797
Author(s):  
Clemmie Stebbings ◽  
Ahmed Latif ◽  
Janakan Gnananandan
Keyword(s):  
Abdominal Pain ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Sudden Onset ◽  
Greater Omentum ◽  
Caribbean Woman ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Fat Stranding

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

scholarly journals Femoral hernia containing the right fallopian tube: chronic pain with menstruation

2019 ◽  
Vol 101 (7) ◽  
pp. e157-e159
Author(s):  
P Marcos-Santos ◽  
M Bailon-Cuadrado ◽  
E Choolani-Bhojwani ◽  
D Pacheco-Sanchez
Keyword(s):  
Fallopian Tube ◽  
Femoral Hernia ◽  
Groin Pain ◽  
Abdominal Ultrasound ◽  
Adult Women ◽  
Hernia Sac ◽  
Anatomical Structures ◽  
Ectopic Testis ◽  
Abdominal Symptoms ◽  
The Right

Femoral hernias represent less than 10% of groin hernias and appear mainly in adult women; incarceration is more usual than in other hernias. Content found within the sac is commonly small bowel or omentum. Other anatomical structures, such as appendix, bladder, Meckel’s diverticulum, ectopic testis, stomach and gynaecological organs are extremely unusual. A 48-year-old woman presented with intense right groin pain over 48 hours. Her past medical history revealed periodical moderate right groin pain coincident with her menstrual cycles, usually self-limited. No abdominal symptoms or fever were present. On physical examination, an incarcerated right femoral hernia was suspected. Subsequently abdominal ultrasound revealed a right femoral hernia containing an echogenic structure with conserved vascularisation. The patient underwent an emergency surgery. During the procedure the right fallopian tube and several small cysts were discovered as the hernia sac contents. As no ischaemic signs were observed, and the sac was sutured and reduced. Femoral hernioplasty was accomplished with polypropylene mesh. The postoperative course was uneventful and the patient was discharged within 24 hours. After an exhaustive literature review, we have found few cases reporting the presence of fallopian tube in adult women with femoral hernia, but none described a recurrent groin pain coinciding with menstruation, as in this case.

scholarly journals Infected femorocele: case report of an extremely rare surgical condition in a middle-aged lady suffering from a painful inguinal swelling

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Sabyasachi Bakshi
Keyword(s):  
Lymph Node ◽  
Femoral Hernia ◽  
Urine Analysis ◽  
Inguinal Lymph Node ◽  
Histopathological Examination ◽  
Stable Condition ◽  
Sensitivity Test ◽  
Inguinal Region ◽  
Hernia Sac ◽  
The Right

Abstract Background The hydrocele of the femoral hernia sac, an extremely rare occurrence, is termed femorocele. Very few authentically reported cases of femorocele are available in the literature. The present case, diagnosed as a case of infected femorocele, was managed successfully by excision of the femorocele sac and repair of the femoral hernia. To the best of the author’s knowledge, it is the first-ever reported case of infected femorocele. Case presentation A 30-year-old lady presented with a painful 3 cm × 2 cm swelling in the right inguinal region. Though the swelling was there for 2 years, the pain and indurations started after a trivial blunt trauma over the swelling 7 days ago. The patient was febrile and mild tachycardic but had no dysuria. The oval-shaped, tense-cystic, poorly translucent, non-pulsatile, non-reducible swelling showed no cough impulse. There was also a (1.5 cm × 0.5 cm) palpable right-sided superficial inguinal lymph node. Routine blood and urine analysis reports were normal except leukocytosis (10,000/mm3) with neutrophilia. Ultrasonography of the right inguino-labial region revealed a mildly echogenic cystic swelling without any intra-abdominal communication. Exploration of the right inguinal region revealed a cystic (3 cm × 2 cm) swelling, medial to the femoral vessels, containing amber-colored fluid. The distal sac was excised, and anatomical repair of femoral canal defect was done after transfixing the neck of the femorocele sac. Fibro-fatty-collagenous tissue with mixed inflammatory cells along with a flattened mesothelial lining cell layer was found on histopathological examination. Sections from inguinal lymph node showed reactive hyperplasia. Culture of fluid from the sac revealed growth of Escherichia coli. The patient was put on anti-inflammatory drugs and antibiotics according to a sensitivity test. Patient was discharged in stable condition after 5 days. Four months after the operation, the patient is doing well, remaining asymptomatic and without any sign of recurrence. Conclusions The hydrocele of the femoral hernia sac is an extremely rare disease. When not infected, it presents a painless inguinal soft cystic swelling, commonly in women of fourth to sixth decade. This was diagnosed intraoperatively in all cases reported till date. Excision of the sac after transfixation of the neck and anatomical repair are the treatment of choice. In elderly patients, with larger defect, the mesh repair can be opted for. The femorocele may also get infected by uropathogens, and proper antibiotics should be used after a sensitivity test.

scholarly journals A Rare Case of De Garengeot Hernia: A Challenging Diagnosis and a New Approach

2021 ◽  
pp. 1-3
Author(s):  
Sleiman Marwan Julien ◽  
Sleiman Marwan Julien ◽  
Litchinko Alexis ◽  
Toso Christian ◽  
Ris Frédéric ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Hernia Repair ◽  
Femoral Hernia ◽  
Clinical Presentation ◽  
Emergency Setting ◽  
Rare Presentation ◽  
Hernia Sac ◽  
Double Approach ◽  
The Right ◽  
De Garengeot Hernia

De Garengeot’s hernia is a rare entity in which the appendix is located within a femoral hernia and is almost invariably encountered incarcerated in an emergency setting. The clinical presentation is usually that of an incarcerated femoral hernia and is indistinguishable from other incarcerated femoral hernias. Here, we report on a 48-year-old female patient, known for a post-operative chronic seroma in the right groin since childhood, with a rare clinical presentation of a De Garengeot hernia. An abdominal CT-scan was performed, revealing an appendicitis with a stercolith in a femoral hernia. Generally, an inguinal approach alone (McVay procedure) is chosen and provides access for both appendectomy and hernia repair. In the absence of concomitant acute appendicitis, trans-abdominal pro-peritoneal laparoscopy (TAPP) could also be used as a single approach. In case of a rare presentation of acute appendicitis with probable contamination of the groin, we propose the double approach of laparoscopic appendectomy and hernia repair either with (if hernia sac is not opened during surgery) or without mesh. This approach is not yet described in the literature, and we think it the best technique to perform the appendectomy and hernia repair with little contamination of the groin.

scholarly journals Laparoscopic Treatment of an Incarcerated Meckel’s Diverticulum in a Femoral Hernia

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Christoph Paasch ◽  
Gianluca De Santo ◽  
Peter Look ◽  
Katherina Boettge ◽  
Michael Hünerbein
Keyword(s):  
Femoral Hernia ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum ◽  
Laparoscopic Treatment ◽  
Hernia Sac ◽  
Experienced Surgeon ◽  
Blind Ending ◽  
The Right ◽  
Transabdominal Preperitoneal Procedure ◽  
Tangential Resection

Meckel’s diverticulum (MD) is the persistence of the omphalomesenteric duct. It is usually asymptomatic but may present with bleeding, infections, and intestinal obstruction. It also may be a content of a hernia sac, a so-called Littre hernia. Herein, we will present the case of a 75-year-old female, who suffered from a painful swelling of the right inguinal region. Ultrasound imaging detected an inguinal hernia with incarcerated blind ending small bowel. Immediately, a laparoscopy was conducted. We diagnosed a right femoral hernia with an incarcerated MD. A TAPP (transabdominal preperitoneal) procedure was performed and the MD tangential stapled. Due to an uneventful postoperative course, the patient left the hospital after two days. An incarceration of a MD in a femoral hernia is rare. Tangential resection of the MD with simultaneous hernia repair in a TAPP technique seems to be a sufficient approach, when it is conducted by an experienced surgeon.

scholarly journals De Garengeot Hernia: Case Report and Review of the Literature of a Rare Femoral Hernia

2021 ◽  
Author(s):  
Leo Licari ◽  
Sofia Campanella ◽  
Claudia Carolla ◽  
Simona Viola ◽  
Giuseppe Salamone
Keyword(s):  
Femoral Hernia ◽  
Abdominal Cavity ◽  
Fluid Collection ◽  
Rare Condition ◽  
Hernia Sac ◽  
Blind Ending ◽  
Tender Mass ◽  
Operative Findings ◽  
The Right ◽  
De Garengeot Hernia

AbstractDe Garengeot hernia is a rare femoral hernia defined as the presence of the appendix within the femoral hernia sac. The incidence of appendicitis in this type of hernia is a rare condition that accounts for 0.08–0.13% of all De Garengeot hernias. We describe the case of a 61-year-old woman that presented at the emergency department with a tender mass (diameter 10 × 8 cm) in the right groin region for 5 days associated with pain in lower right abdomen and accompanied by fever (38 °C). Computed tomography (CT) of the abdomen revealed the presence of a complex fluid collection with small foci of air in the right inguinal region, measuring 9 × 7 × 10 cm in the 3 orthogonal dimensions and a blind ending tubular structure extending from the caecal base into the groin mass through a narrowed neck defect, medial to the common femoral vessels. The CT scan demonstrated the suspected diagnosis of De Garengeot hernia complicated by acute appendicitis. The intra-operative findings confirmed the diagnosis. The patient was successfully managed operatively. The surgical strategy took into account the need to significantly reduce the diffusion of the infection inside the abdominal cavity. The patient was discharged on the fifth postoperative day without peri-/postoperative complications.

scholarly journals Emergency surgery in an elective setting: a case report detailing incidental diagnosis of a de Garengeot hernia

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Conor Brosnan ◽  
Shane Keogh ◽  
Jarlath C Bolger ◽  
Kevin Farrell ◽  
Enda Hannan ◽  
...  
Keyword(s):  
Femoral Hernia ◽  
Elective Surgery ◽  
Rare Complication ◽  
Vermiform Appendix ◽  
Hernia Sac ◽  
First Case ◽  
Satisfactory Outcome ◽  
Elective Setting ◽  
Decisive Action ◽  
De Garengeot Hernia

Abstract We present a case of acute appendicitis within an incarcerated femoral hernia. This is a rare complication of the phenomenon eponymously known as a ‘De Garengeot Hernia’, which describes a vermiform appendix in an incarcerated femoral hernia sac. Our case is somewhat unique in the manner by which the affected patient had presented. Attending hospital for an unrelated elective surgery, an incarcerated hernia was diagnosed at time of admission. Thorough assessment in advance of the procedure and decisive action led to a satisfactory outcome. This may be the first case in literature reporting a ‘De Garengeot Hernia’ presenting in such a fashion.

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