OV04 MASSIVE INGUINAL-SCROTAL HERNIA WITH RETROPERITONEAL CONTENTS AND URETER: VIDEO CASE REPORT OF ROBOTIC REPAIR USING INTRAOPERATIVE FLUORESCENCE IMAGING

Aim Inguinal hernias containing the ureter and retroperitoneal contents are uncommon. We present a robotic repair of a large inguinal-scrotal hernia containing the ureter as a video case presentation. Material and Methods A 66 year old male with no previous abdominal surgical history presents with a large left sided inguinal-scrotal hernia, as well as smaller ventral and right inguinal hernias. On CT imaging the patient was found to have an ectopic pelvic location of the left kidney with evidence of the left ureter coursing into the hernia with a significant amount of retroperitoneal fat. The patient was taken to the operating room for a robotic bilateral inguinal hernia repair and ventral hernia repair. Results A ureteral catheter was placed preoperatively and instilled with indocyanine green (ICG). The hernias were successfully repaired, and intraoperative fluorescence imaging was successfully used to visualize the ureter as it was reduced with the hernia sac. The robotic platform significantly aided in dissection of the large volume of retroperitoneal fat, while being able to quickly transition to intraoperative fluorescence to clearly visualize the course of the ureter. The patient did well post operatively with no complications. Conclusions We present a video case report of a large ureter-containing inguinoscrotal hernia that was successfully repaired using a robotic preperitoneal approach. Use of the robotic platform and indocyanine green/intraoperative fluorescence imaging were helpful adjuncts in aiding dissection by improving intraoperative visualization of the ureter.

UNILATERAL SCROTAL HERNIA WITH DUAL URETER HERNIATION: THE FIRST EXPERIENCE OF SUCCESSFUL SURGICAL CORRECTION

Objective of the study: the purpose of the research, based on the example of a specific clinical case, is to draw the attention of specialists to a specific approach to the diagnosis and treatment of the inguinal hernia with atypical contents. A rare, unpublished in the Slovak Republic, observation of the left-sided scrotum hernia with dual ureter herniation in combination with congenital kidney pathology in a 3-month-old boy is presented. The diagnosis was based on physical examination, ultrasound examination, radiography, scintigraphy, and urethrocystoscopy. This anomaly has been successfully corrected through several successive phases of the operation. Conclusion: the combination of scrotal hernia and congenital renal anomaly may indirectly indicate a possible hernia in the distal part of the ureter and requires a thorough examination, including additional imaging methods.

A CASE OF GIANT INGUINO- SCROTAL HERNIA

• An inguinal hernia is a protrusion of the contents of the abdominal cavity or peritoneal fat through a defect in the inguinal area. • The hernia sac contents are at risk of incarceration, which may lead to more serious sequelae such as bowel obstruction, and or a circulatory strangulation of the hernia contents, leading to necrosis and possible perforation of the intestine . The chance of incarceration is relatively low, between 0.3-3% per year . • GAINT INGUINAL HERNIA IS MORE UNUSUAL (APPROX 0.5% OF INGUINAL HERNIAS) AND SIGNIFICANTLY CHALLENGING IN TERMS OF SURGICAL MANAGEMENT. • IT IS DEFINED AS AN INGUINAL HERNIA THAT EXTENDS BELOW THE MIDPOINT OF INNER THIGH WHEN PATIENT IS IN STANDING POSITION.

GIANT INGUINO-SCROTAL HERNIA WITH DUODENAL PERFORATION AND BILIARY PERITONITIS - A RARE CASE REPORT WITH LITERATURE REVIEW

Background: Giant inguino-scrotal hernias are unusual, and associated with duodenal perforation causing peritonitis is an extremely rare presentation. Case presentation: A 73 year old gentleman presented to the Emergency department (ED) with sudden onset of lower abdominal pain, bilious vomiting, and constipation. He had a huge right sided inguino-scrotal swelling. Computed tomography (CT) abdomen showed massive inguino-scrotal hernia containing pylorus, part of duodenum and loops of jejunum, ileum and large bowel upto descending colon as contents with signs of perforation. Labs were suggestive of sepsis. At emergency surgery, perforation of the second part of duodenum with generalized peritonitis was evident. Closure of the perforation and drainage was done as a damage control procedure and definitive hernia repair was deferred for a later period. Despite intensive-care, the patient succumbed to sepsis postoperatively. Conclusion: This is a rare presentation of duodenal perforation secondary to giant inguino-scrotal hernia causing biliary peritonitis ensuing in sepsis and death. We reviewed the literature on giant inguinal hernia, and especially those associated with duodenal perforation.