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 Rare Case of Large Bowel Injury due to Direct Blunt Trauma to a Preexisting Femoral Hernia

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
C. Tinner ◽  
M. Odermatt ◽  
P. Villiger
Keyword(s):  
Blunt Trauma ◽  
Femoral Hernia ◽  
Bowel Perforation ◽  
Colorectal Anastomosis ◽  
Oral Feeding ◽  
Inguinal Region ◽  
Emergency Laparotomy ◽  
Time Interval ◽  
Hernia Sac ◽  
Left Inguinal Region

We report a case of an 85-year-old man with a known asymptomatic left femoral hernia who was admitted to the emergency ward a few hours after falling from a bicycle and suffering from blunt trauma of the handlebar to the left inguinal region. The clinical findings and a computed tomography (CT) scan detecting free air in the femoral hernia sac suggested bowel perforation. Emergency laparotomy 6 hours after the incident confirmed a tear of the sigmoid colon accompanied by free blood and faeces in the left inguinal region of the abdomen. A segmental sigmoid resection and a primary end-to-end colorectal anastomosis were performed. The postoperative course was complicated by delayed oral feeding, a local infection, and a partial left testicle necrosis that led to secondary resection. The patient was discharged after 32 days of in-hospital care. Three months post trauma, we recorded a restitutio ad integrum. The case exemplifies that blunt trauma to preexisting femoral hernias may cause potentially lethal bowel perforation and that the time interval between time of injury and surgical treatment may be a prognostic factor. CT scans seem most suitable for ruling out bowel perforation. The scarce literature for blunt trauma to hernias is reviewed.

scholarly journals MON-482 Thyroid Tuberculosis - An Unlikely Diagnosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Alexandra Novais Araújo ◽  
Tânia Matos ◽  
Ema Nobre ◽  
Maria Joao Bugalho
Keyword(s):  
Lymph Node ◽  
Fine Needle Aspiration ◽  
Histopathological Examination ◽  
Extrapulmonary Tuberculosis ◽  
Needle Aspiration ◽  
Tuberculous Infection ◽  
Rare Presentation ◽  
Adequate Treatment ◽  
Fine Needle ◽  
The Right

Abstract Background: Mycobacterium tuberculosis (MTB) is an aerobic bacillus responsible for the most cases of tuberculous infection. Approximately one-third of the world’s population is infected. Tuberculosis (TB) of the thyroid gland is an unusual diagnosis with an estimated prevalence of 0.1 to 0.6%. The thyroid TB can mimic different pathologies (thyroid neoplasms, lymphoma, infectious or granulomatous thyroiditis, Graves’ disease or bacterial abscess) and the diagnosis can be easily disregarded, especially in non-endemic countries and if the patient doesn’t have systemic symptoms. The fine needle aspiration and histopathological examination, with acid-fast bacilli staining and TB culture, are the gold standard exams. Clinical Case: A 71-year-old female was referred to our Endocrinology department after a diagnosis of nodular thyroid disease. She had complaints of slight cervical discomfort, with 6 months of duration. She hadn’t personal or familiar relevant antecedents. At observation, a movable, elastic and non-tender nodule of 15mm at the right superior thyroid lobe was identified. Blood tests including a thyroid profile were normal. The neck ultrasound showed, at the right lobe of the thyroid, multiple solid nodules; the dominant had 18mm, was heterogeneous and had multiple calcifications. Moreover, lymph nodes with suspicious ultrasonographic features along the right internal jugular chain were reported. The patient underwent fine-needle aspiration (FNA) of the suspicious thyroid nodule and one lymph node. Results were respectively: non-diagnostic (Bethesda I) and reactive pattern. FNA was repeated on a different occasion and results were similar. Due to ultrasound suspicious of malignancy, a total thyroidectomy was performed and a lymph node from level IV was sampled for extemporaneous examination. Necrotizing granulomas were documented; the Ziehl-Neelson staining (ZNS) was negative; material was sent to microbiology. Following this finding, ganglion emptying was not performed. The thyroid histology showed tuberculoid type granulomas with lymphoid border and central necrosis. However, the ZNS was negative. The diagnosis was definitely established by a positive culture of the lymph node tissue and molecular detection, by polymerase chain reaction (PCR), of MTB. Pulmonary involvement was excluded and she started antituberculous agents planned for 9 months (rifampicin and isoniazid during 9 months and ethambutol and pyrazinamide for 2 months). Conclusion: Thyroid TB is a rare presentation of extrapulmonary tuberculosis. In presence of systemic or specific complaints or history of exposition the diagnosis may be suspected and confirmatory tests requested in order to ensure an adequate treatment. However, sometimes, histopathology remains a key step and the use of cultures improves the sensitivity and specificity of TB tests.

scholarly journals Perineal Hernia in a Bitch

2020 ◽  
Vol 48 ◽  
Author(s):  
Ângela Valentina De La Porta Machado ◽  
Gabriela Lugoch ◽  
Ana Paula Ibarra dos Santos ◽  
Maria Eduarda Pons Gonçalves ◽  
Marília Teresa De Oliveira ◽  
...  
Keyword(s):  
Physical Examination ◽  
Surgical Procedure ◽  
Perineal Hernia ◽  
Inguinal Region ◽  
Ultrasound Scan ◽  
Hernia Sac ◽  
Pelvic Diaphragm ◽  
Perineal Region ◽  
The Right ◽  
Left Inguinal Region

Background: Perineal hernia is characterized by the displacement of abdominal organs to the perineal region after rupture or weakening of the pelvic diaphragm muscles. This condition is common among middle-aged and elderly unneutered male dogs. Considering the severity of the condition and its rarity among bitches, this paper reports on a case of perineal hernia caused by hydrometra in a 12-year-old pinscher bitch.Case: The patient was a 12-year-old Pinscher bitch, weighing 3 kg, suffering from anuria and constipation in the 36 h prior to treatment, without reported trauma. She was unspayed, and her last estrus had occurred approximately thirty days previously. The physical examination revealed an increase in volume in the right perineal region, increased volume in the left inguinal region, increased body temperature (39.8ºC), pale mucous membranes, tachycardia, tachypnea, abdominal pain and increased popliteal lymph nodes. The diagnosis was determined based on her medical history, clinical signs and an ultrasound scan, which revealed dilated uterine horns displaced unilaterally in the left inguinal region, with evidence of hydrometra, full urinary bladder inside the hernia sac in the right dorsolateral perineal region and right kidney pyelectasis. After evaluating the animal’s physical condition, surgery was recommended, involving ovariohysterectomy associated with inguinal and perineal herniorrhaphy.Discussion: Perineal hernia, a common condition in male dogs, is characterized by the displacement of organs towards the perineal region. However, in this case, this condition occurred in female dog. Unlike males, the main causes of perineal hernia in females are trauma, chronic coughing related to heart disease, bronchitis, and tracheal collapse. Increased intra-abdominal pressure associated with a weak pelvic diaphragm predisposes for herniation of abdominal contents, such as occurred through hydrometra. In this case, other factors that could pertain to the etiology of perineal hernia were excluded, given the absence of trauma or secondary diseases. The diagnosis was made based on a physical examination and ultrasound scan. Pre-surgical biochemical blood tests were also performed. The chosen treatment was ovariohysterectomy followed by inguinal and perineal herniorrhaphy. The traditional surgical procedure to reduce the perineal hernia was employed, using approximation sutures due to the easy apposition of wound edges. The structures and soft tissues involved showed no changes in color or texture, thus obviating the need for more elaborate techniques, which are employed in the case of relapse or muscle atrophy. The patient showed clinical evolution after surgical correction, with decreased perineal volume and recovery of urinary function (normuria). The patient was discharged after 72 h, and six months after the surgical procedure, she presented no clinical alteration, according to information provided in a telephone call by her owner. It is believed that the increase in volume caused by the presence of hydrometra was the determining factor for the development of inguinal and perineal hernias. It is suggested that alterations causing uterine enlargement be investigated in order to include perineal hernia in female dogs as a differential diagnostic tool.

scholarly journals The Pedicled Flap of Adductor Longus, a New Technique for Inguinal Reconstruction

2021 ◽  
Vol 8 ◽  
Author(s):  
Hong Zhang ◽  
Zhenfeng Li ◽  
Jianmin Li ◽  
Lei Zhu ◽  
Yakubu Ibrahim
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Inguinal Lymph Node ◽  
Pedicled Flap ◽  
Local Resection ◽  
Inguinal Region ◽  
Node Dissection ◽  
Inguinal Lymph Node Dissection ◽  
Adductor Longus

Introduction: Reconstruction surgeries of the inguinal area pose a challenge for oncological and orthopedic surgeons, especially after radical local resection (RLR), radical inguinal lymph node dissection (RILND), or both. Although numerous surgical procedures have been reported, there is no report about a pedicle adductor longus flap method. The aim of this work is to show our experience about inguinal reconstruction with pedicled adductor longus flap and associated outcomes.Patients and Methods: A retrospective study of 16 patients with localized inguinal region interventions and reconstructed by adductor longus flap from March 2016 to July 2020. Patients' average age was 60.0 years (range = 38–79 years) and had postoperative follow-up of 10 months (ranging 2–19 months). All patients had unilateral inguinal region involvement—seven cases on the left and nine cases on the right. The patients' clinical course, operative course, and postoperative follow-up data were evaluated.Results: All 16 patients recovered well post-operatively and did not require any re-intervention. Four patients experienced negligible discomfort around the groin area. Five patients experienced a minor strength deficit in thigh adduction compared with that of preoperative strength in the same or contralateral leg. The aforementioned complications resolved during the postoperative course and had no functional impact on their activity of daily living. All adductor longus flaps survived, completely filled the inguinal dead space, and wounds healed uneventfully within 3 weeks except for three patients who suffered delayed wound healing for more than 4 weeks. Other common complications such as infection, seroma, or wound dehiscence were not encountered in this series.Conclusion: The adductor longus flap is a reliable alternative method for inguinal region reconstruction following radical local resection (RLR), radical inguinal lymph node dissection (RILND), or both.

scholarly journals Description of the rare localization of Dirofilaria repens in human in the right inguinal lymph node

IDCases ◽  
2021 ◽  
Vol 23 ◽  
pp. e01010
Author(s):  
Larisa Ermakova ◽  
Sergey Nagorny ◽  
Igor Kornienko ◽  
Julia Kiosova ◽  
Sergey Todorov ◽  
...  
Keyword(s):  
Lymph Node ◽  
Inguinal Lymph Node ◽  
Dirofilaria Repens ◽  
The Right

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 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 Malignant nodular hidradenoma-inguinal region clinically masquerading as squamous cell carcinoma: a case report

2019 ◽  
Vol 7 (7) ◽  
pp. 2848 ◽  
Author(s):  
Sunita S. Vernekar ◽  
Priyadharshini Bargunam
Keyword(s):  
Inguinal Lymph Node ◽  
Inguinal Region ◽  
Sweat Glands ◽  
Skin Tumour ◽  
History Of ◽  
Nodular Hidradenoma ◽  
The Right ◽  
Wedge Biopsy ◽  
Eccrine Sweat Glands ◽  
Adnexal Tumour

Malignant Nodular hidradenoma is an extremely rare aggressive tumour originating from eccrine sweat glands with an incidence of <.001%. So far less than 80 cases have been reported in the literature. It’s known for its local recurrence (50%) and metastasis (60%) and hence early diagnosis and radical treatment is mandatory. But differentiating it from its benign counterparts and other skin tumour mimics is challenging, due to its histopathological similarity & lack of diagnostic immunomarkers. Authors report a case of 65-year-old female who presented with a short 4-month history of rapidly growing ulceroproliferative growth in the right inguinal region with bilateral inguinal node enlargement, associated with pain and discharge. Wedge biopsy of left inguinal lymph node showed malignant cutaneous adnexal tumour deposits, which after excision was typed as malignant nodular hidradenoma. It was confirmed with immunohistochemistry. Patient presented with recurrence 8 months after excision.

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.

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