Laparoscopic repair of femoral hernia involving the bladder with coexisting indirect inguinal hernia in a young man: a case report

Background Bladder hernias are rare conditions that are difficult to diagnose preoperatively; many cases are diagnosed intraoperatively or postoperatively due to bladder injury. Most bladder hernias are direct inguinal hernias that involve the bladder in obese men older than 50 years old. We describe a rare case of a left femoral hernia involving the bladder in a young man. Case presentation A 32-year-old man with a bulge in the left inguinal region underwent laparoscopic transabdominal preperitoneal repair. Laparoscopy revealed a left indirect inguinal hernia. When the preperitoneal space was dissected toward the Retzius space along the vesicohypogastric fascia, the bladder was found to be protruding into the femoral ring and adhere to the hernial orifice severely. The bladder was reduced carefully without causing injury. After dissection, we repaired the left myopectineal orifice with a mesh. The patient was discharged on postoperative day 1 without complications. No recurrences or symptoms were noted at the 12-month follow-up. Conclusions A femoral hernia involving the bladder in a young man is rare. This case demonstrated that dissection along anatomical landmarks is important for preventing injuries to the bladder because even young men may have bladder hernias.

Spontaneous enterocutaneous fistula in a patient with femoral hernia: a case report

Background Enterocutaneous fistula commonly occurs in the post-operative setting. However, a handful of cases have been reported to occur secondary to strangulation of hernia, mostly femoral due to the narrow femoral ring through which this type of hernia passes through. Case presentation We encountered a case of spontaneous fecal fistula, which occurred in the setting of an incarcerated femoral hernia. The patient did not develop peritonism, or obstruction, throughout the course of the disease. The hernia ruptured on day 7 of incarceration. Exploratory laparotomy under epidural anesthesia revealed a femoral hernia with ileum as content, arising approximately 20 cm from the ileocecal junction. Reduction of the contents was done, and a resection performed along with repair of the hernia. Conclusion As very few literature describe the formation of spontaneous fecal fistula, we discuss the presentation in this report.

Case of Incarcerated Femoral Hernia Treated with Laparoscopic Surgery after Groin Hernia Repair

An 81-year-old man was brought to our hospital due to a suspicion of left incarcerated femoral hernia. He was previously diagnosed with incarcerated left groin hernia and was treated using the mesh plug method 1 month back at another hospital. Abdominal computed tomography scan revealed small bowel obstruction, incarcerated bowel, and compression of the left femoral vein. Thus, the patient was diagnosed with incarcerated femoral hernia. An emergency laparoscopic surgery was then performed, and we found that the small bowel was incarcerated into the let femoral ring and was necrotic. However, there was no recurrence of left inguinal hernia. The small necrotic bowel was resected and the femoral ring was repaired. The patient was discharged 8 days after the surgery, and there was no recurrence of femoral hernia after 1 year.

Method of Anterior Femoral Region Preparation for Establishing the Fetal Anatomical Variability of Vasculonervous Formations

Determining of projection-syntopic relationships of vasculonervous structures within the femoral ring, femoral triangle, and obturator and adductor canal in human fetuses is particularly important in fetal surgery, and requires the use of an appropriate set of methods of morphological examination. Obtaining data on the topographic and anatomical features of nerves, superficial and deep blood vessels of the anterior femoral region during the fetal period of human ontogenesis is a topical urgent task of fetal anatomy. The purpose of the study was to determine the method of the most rational sequence of actions during the preparation of the vasculonervous structures of the anterior femoral region in human fetuses to obtain standard results suitable for comparison in the age aspect. Material and methods. The study was performed on 80 human fetuses 81.0-375.0 mm parietal-coccygeal length using macromicroscopic preparation. After the selected sequence of preparation of nerves and vessels of the anterior femoral region in human fetuses 4-10 months we used additional methods such as vascular injection, surface staining of dissected vessels and nerves and morphometry to determine the forms of their age and individual anatomical variability. Results and discussion. The chosen sequence of preparation of nerves and vessels of the anterior femoral region in human fetuses allowed determining the forms of their age and individual anatomical variability. In particular, features of intramuscular branching of nerves and arteries in the muscles of the anterior and medial femoral groups, anatomical variability of the femoral artery and its branches, variant anatomy of the great saphenous vein, characterized by variability in shape, topography and bilateral asymmetry of its tributaries and formation of anastomoses were found in human fetuses. The identified connections and complexes of the femur cutaneous nerves, as well as areas of overlap and displacement are compensatory mechanisms in the peripheral nervous system and are observed not only between ontogenetically related nerves, but also nerves of different segmental affiliation. Conclusion. The proposed and tested method of preparation of vasculonervous structures of the anterior femoral region in human fetuses provides a standard for obtaining data on their typical and variant anatomy. The sequence of actions used during the preparation of the vasculonervous formations of the anterior femoral region of the human fetus preserves the natural appearance and relationships between the structures of the object of study. Age-related and individual fetal anatomical variability of vasculonervous formations of the anterior femoral region was discovered during the gradual preparation of the lumbar plexus branches, superficial and deep veins of the lower extremities, superficial and deep inguinal lymph nodes, and femoral artery branches

FEMORAL HERNIA MASQUERADING AS ACUTE GROIN PAIN: A DIAGNOSTIC AND SURGICAL CHALLENGE

Femoral hernia is a type of groin hernia, where the content protrudes through the femoral ring. Common contents in femoral hernias are, preperitoneal fat and small bowel, in some rare cases, sac containing an appendix, Meckel's diverticulum, ectopic testis, and stomach are reported.1 A femoral hernia presents as a mass or bulge below the inguinal ligament. Sometimes, femoral hernia presents as a bulge over the inguinal canal. In this case, the femoral hernia still exits inferior to the inguinal ligament through the femoral canal but ascends in a cephalad direction.2 Sometimes, femoral hernias may present in an occult manner with unexplained pain in the groin. We report a single case of Richter’s type strangulated femoral hernia at a tertiary care apex institution of Eastern India. This case of femoral herniation presented atypically as groin pain without any swelling initially. This was followed by swelling with pain at the groin above the inguinal ligament after a few days.

Richter Paraumbilical Hernia Managed by Invagination: A Case Report and Review of Literature

Background: Richter hernia is a peculiar type of enterocele, which may progress to fatal bowel perforation unless early intervention is made. It used to occur at femoral ring but occurrence at ventral hernia is extremely rare. Case presentation: We report a 60-year-old female patient with tender paraumbilical hernia with absolute constipation and vomiting. On examination the patient had a low-grade fever, while the swelling was tense, tender with no impulse on cough. Plain radiograph abdomen erect position was done revealing multiple air fluid level. Repair was done after invagination of the ischemic part of the bowel loop. Conclusion: ventral hernia may be of a Richter type. Management of ischemic loop in Richter hernia does not necessitate resection and anastomosis, as invagination only is enough. Repair of the defect is mandatory while mesh placement is conditional.

Risk Factors Associated With Femoral Ring Allograft Breakage in ALIF

Study design: This is a retrospective chart review. Objectives: To identify the incidence of, and variables correlated with, femoral ring allograft (FRA) fracture following anterior lumbar interbody fusion (ALIF). Methods: All patients who underwent ALIF using FRAs at an academic institution over 10 years were included. Postoperative radiographs were reviewed by both the primary and senior authors; fracture and no-fracture groups were created for comparison. Patient and surgical characteristics were extracted from electronic medical records. Frequency data comparisons were performed using contingency table analysis; comparisons of means were analyzed for continuous variables. A multivariate linear regression model was developed using screw use, graft height <12 mm, index level, and weight as variables. Results: A total of 76 FRAs in 59 patients were identified, 13 (17%) of which fractured. Age, sex, smoking status, use of buttress screws, weight, index level, and presence of spondylolisthesis were not correlated with incidence of fracture ( P > .05). There was a significant correlation between the height of FRA and incidence of fracture; 2% (1/52) of grafts ≥12 mm and 50% (12/24) of grafts <12 mm fractured ( P < .0001). Using ordinary least-squares regression, this result was independent of patient weight, use of screws, and index level. Of 10 patients, 9 did not require revision surgery to achieve fusion. Conclusions: Graft height was the only variable correlated with incidence of FRA fracture. Graft height <12 mm is an independent risk factor for FRA fracture in patients undergoing ALIF, and their use should be avoided in ALIF procedures.

Groin hernias: causes, diagnostics, and surgery

Groin hernias occur in 27–48% of men and 3–6% of women during lifetime. Among the causes are inherited or age-related connective tissue or muscular dysplasia, lack of diverticular obliteration in fetal parietal peritoneum, pre-peritoneal lipomas migrating into the hernia ring, and congenital, postpartum, or postoperation dilation of the femoral ring. Physical examination and examination of the preperitoneal space reveals hernia in 93% and 100%, respectively, yet ultrasound examination, computed tomographic peritoneography, magnetic resonance imaging are also employed to confirm the diagnosis. An established technique for the treatment of groin hernias includes opening the inguinal canal, high ligation of the hernia sac, and repair of the inguinal canal, altogether termed herniorrhaphy. Suprapubic or inguinal incision permits closure of the hernia sac without involving the inguinal canal (herniotomy). Implementation of synthetic meshes led to the increase in hernioplasty, i.e. reinforcement of the inguinal canal upon the inguinal canal repair. Laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) hernioplasty became widely used along with the development of endoscopic surgery. In these techniques, mesh is placed between the peritoneum and transversalis fascia, closing both inguinal canal and femoral ring. Overall, modern surgical techniques reduced the time of treatment, disability and disease recurrence to 1.4–2%.

Incarcerated Femoral Hernia Repair with Ventralex™ Hernia Patch through Same Skin Incision and Suprainguinal Laparotomy

Purpose. To report our experience with incarcerated femoral hernia procedure, which allows laparotomy through same inguinal skin incision, inspection and resection of compromised bowel, and preperitoneal tension-free transabdominal repair with Ventralex™ Hernia Patch.Materials and Methods. The suprainguinal laparotomy was performed via same groin incision without compromising iliopubic tract. The femoral ring was sealed with Ventralex™ Hernia Patch pulled through the abdominal cavity and secured outside. Five consecutive patients diagnosed with incarcerated femoral hernias were operated. All of them required laparotomy, either for bowel resection (n=3) or for inspection of viability (n=2).Results. All patients tolerated the procedure well. There were no wound or mesh infections, incisional hernias, or recurrences during follow-up.Conclusions. Our easy-to-master operative approach to incarcerated femoral hernia allows easy access to abdominal cavity through same groin incision without compromising iliopubic tract or midline laparotomy. Reduction of incarcerated bowel and its inspection and resection can be safely performed. The femoral ring defect can be effectively obliterated with Ventralex™ Hernia Patch.