A Case of Functional Testicular Torsion Caused by Incarcerated Inguinal Hernia in a Newborn

Testicular torsion in neonates is a urologic emergency with an incidence of 6.1 per 100,000 live births. Incarcerated inguinal hernia is also an emergency with an incidence of approximately 6% to 31% in children with inguinal hernia. Functional testicular torsion from an incarcerated inguinal hernia is a rare event in children, often not considered in the initial evaluation. A 19-day-old newborn boy was admitted to our neonatal intensive care unit after visiting a primary clinic. He presented with inconsolable crying and right scrotal swelling. Upon initial physical examination, a hard palpable mass and swelling was found in the inguinoscrotal region, accompanied with redness and warmth of the scrotum. Scrotal ultrasound with color Doppler showed inguinal hernia with strangulation and scanty blood flow to the testis. The patient underwent a right orchiectomy and partial resection of the affected small bowel. Surgical findings confirmed a testicular torsion and incarcerated inguinal hernia with testis with small bowel necrosis. Here, we report a rare case of a newborn with functional testicular torsion as a result of prolonged spermatic cord compression due to incarcerated inguinal hernia.

INCARCERATED INGUINAL HERNIA IN NEWBORNS AND INFANTS

Introduction. Inguinal hernias (IG) in children are a congenital pathology of the processusvaginalis and a local manifestation of the syndrome of mesenchymal insufficiency. Incarcerated IG is the most common and dangerous complication, the risk of which is significantly higher in children during the first 3 months of life. To date, there is no perfect method of pinched IG treatment in newborns and infants. Data on the optimal timing of herniotomy in newborns and infants are also insufficient and contradictory.The aim of this study is to provide our own experience in the treatment of infants with pinched inguinal hernias.Material and methods. The material of this study is 97 newborns and infants with irreducible and incarcerated inguinal hernias. Diagnosis was based on anamnesis data, physical examination methods and ultrasound data with inguinal and scrotal Doppler. Indications for review radiography of the abdominal cavity were clinical signs of acute intestinal obstruction.Results and discussion. Analyzing the obtained results, we have found that the diagnosis of hernias in 91 (93.81%) children was based on anamnestic data, complaints of parents about the presence of bulging in the groin area and physical examination of a child. The most important condition for effective diagnosis is the thorough collection of anamnestic data to determine the duration of the acute condition in a child and its dynamics. It is important to examine a child in a horizontal and vertical position. Differential diagnosis of incarcerated IG in infants was performed with acute hydrocele, torsion of the spermatic cord, inguinal lymphadenitis, etc., which are very similar to incarcerated IG in small children.Treatment of incarcerated inguinal hernias in newborns and infants has been carried out using a combined strategy, which involved the use of conservative invagination of hernia contents (49.48% of patients) followed by delayed surgical correction and emergency surgery according to urgent indications (42.27% of infants).Among 48 children treated conservatively, non- operative manual hernia invagination (Taxis - method) was effective in 46 of them or 95.83%. We used this method in children with a strangulation period up to 12 hours in the absence of inflammation signs in the pinched area.Indications for urgent herniotomy were: strangulation period of more than 12 hours (12 children), ineffectiveness of conservative treatment for 1 hour (2 patients), intractable hernia protrusion in girls (27 patients).As for the planned surgery, we support surgical correction of inguinal hernias at the age of 6-12 months, which we consider optimal.Conclusions1. Conservative manual invagination of an incarcerated inguinal hernia in newborns and infants is used in terms of pinching the contents of the hernia lasting up to 12 hours and is effective in 95.83% of cases.2.Surgical intervention for incarcerated hernia in infants should be performed in children with a duration of pinching more than 12 hours, in cases of impossibility and / or ineffectiveness of conservative invagination for 1 hour and in girls.3. Correction of a incarcerated inguinal hernia in girls is not recommended due to the high risk of ovarian damage.

P145 DERMOID CYST MASQUERADING AS INCARCERATED INGUINAL HERNIA

Aim “For pre operative optimization and educational purposes, rare possibilities should be included in the differential diagnosis”” Material and Methods “CASE REPORT. Inguinal hernia is one of the common operations done by surgeons, often diagnosed clinically. Here we present a case of 29 year old male patient presented with inguinal swelling for 3 years. He was admitted for the surgical ward as a case of incarcerated inguinal hernia for elective repair under GA. Intra op the mass was not consistent with inguinal hernia, two other possibilities were a concern that can cause the swelling; 1) testes, which was excluded by examining the scrotum, 2) Dermoid/Epidermoid cyst which was checked by the mass content of hair and pasty fluid” Results “DERMOID CYST” Conclusions “Most surgeons depend on clinical picture in diagnosing inguinal hernia, thus even other rare possibilities should be included in the differential diagnosis. Unusual presentations of inguinal hernia should be having radiological evaluated.”

VP020 ENDOSCOPIC PREPERITONEAL APPROACH IN STRANGULATED INGUINAL HERNIA

Aim According to the clinical sympthoms and radiological findings minimal invasive surgery can be an option to repair an strangulated inguinal hernia. Material and Methods We present the different ways we have used in our Hospital to treat incarcerated inguinal hernia combining endoscopic preperitoneal and laparoscopic approach Results Multiple treatment schemes are possible for inguinal incarcerated hernia. The choice must be made according to the surgeońs experience, patient´s characteristic and the risk of intestinal ischemia. Laparoscopy combined with preperitoneal endoscopic inguinal repair allows us to explore and to treat possible complications of intestinal ischemia with no need of laparotomy. Conclusions Laparoendoscopic techniques are an option to consider when treating an incarcerated inguinal hernia, even if bowel resection is needed. Thanks to laparoscopic approach, laparotomy can be avoided in many cases.

P038 MINIMALLY INVASIVE SURGERY & INCARCERATED INGUINAL HERNIA. CAN WE COMBINE THEM?

Aim After a long experience of more than 20 years in TEP hernioplasty we explore if it can also be suitable for emergency patients. Material and Methods We present different laparoendoscopic schemes that we have used in our Hospital to treat strangulated inguinal hernia according to clinical and radiological findings. Results TEP in now assumed to be one of the best options in scheduled surgery to treat inguinal hernia. Is now the time to change the paradigm by using it also in emergency surgery? Incarcerated inguinal hernia presents two problems: first of all the clinical emergency, an irreducible inguinal bulge that causes pain, obstruction and bowel ischemia; and second, the need to repair inguinal wall. While treating both problems, we have explored different minimally invasive surgery approaches according to each patient´s characteristics and the preoperative risk of intestinal resection based on CT findings. To reduce the incarcerated bulge, we use a laparoendoscopic methods. After a preperitoneal dissection, and with the help of external maneuvers, we try to reduce the content. If we are not successful, a quelotomy becomes necessary. To treat the inguinal defect we use TEP or TAPP approaches. Conclusions We seek to show that endoscopic preperitoneal approach in an incarcerated inguinal hernia is safe and possible, allowing us to maintain minimal invasive techniques. Laparoscopy allows us to explore and to treat possible complications of intestinal ischemia with no need of laparotomy. Multiple treatment schemes are possible for inguinal incarcerated hernia. The choice must be made according to the surgeońs experience, patient´s characteristic and the risk of intestinal ischemia.

TP7.2.6 Frequency of Obstructed Inguinal Hernia in Infants

Inguinal hernia in children is the result of the failure of obliteration of processus vaginalis or weakness of the abdominal wall. The incidence of inguinal hernia ranges from 0.8-5%. It is more common in preterm babies with an incidence of up to 30%.There is disagreement concerning the management of inguinal hernia in infants worldwide with few in favor of early repair of the hernia due to fear of incarceration while some are against it. This study was conducted to determine the frequency of intestinal obstruction in infants with an inguinal hernia for the development of a proper protocol for the management of inguinal hernias. Methods A total of 112 patients were included in the study. The patient’s gender and age were recorded. The presence of hernia was confirmed clinically and by performing an ultrasound. All the relevant data was recorded in a pre-designed printed proforma. Results In this study, 112 children were included. 73% of children were in the age between 1-6 months and 27% children were in age between 7-12 months. The mean age was 5 months ±5.87. Male children were 86% and female children were 14%. An obstructed inguinal hernia was observed in 11% of children while 89% of children didn’t have obstructed inguinal hernia. Conclusion Our study concludes that the frequency of incarcerated inguinal hernia was 11% in infants mostly occurring at a younger age and in male children.

Inguinal Hernia with Incarcerated Loop of Sigmoid Colon and Impacted Hard Fecolith in an Infant: Rare Presentation

Incarcerated inguinal hernia is not an uncommon occurrence and the rate of incarceration in inguinal hernias has been variably reported between 3 and 16% with higher incidence among infants. Sigmoid colon as a content of hernia is itself an uncommon occurrence and associated impacted large and hard fecolith makes it a rare case in pediatric age group. Only single published case report could be found depicting these findings in young age group. Here we report 1-year-old child presented with 24 hours history of obstructed left-sided inguinal hernia. On exploration loop of sigmoid colon was identified with impacted fecolith.