Abdominal wall

This chapter outlines the management of the patient with a inguinal hernia, femoral hernia, ventral hernia, incisional hernia, other less common abdominal wall hernias, rectus sheath haematoma or groin disruption. It details how to approach a patient with a groin swelling.

Thrombosed Aneurysm of Superficial Epigastric Vein Simulating Inguinal Hernia: Report of Two Cases

Aim. Presentation of two cases of superficial epigastric vein aneurysm simulating inguinal hernia. To our knowledge, only one other case is reported in the literature. Case presentation. The first case was a 34-year-old female with left inguinal pain and swelling which was clinically diagnosed as inguinal hernia. The second case was a 28-year-old female with inguinal pain and swelling, depicted with triplex ultrasonography and computed tomography, and was suspected to have inguinal hernia or enlarged inguinal lymph node. During the surgical exploration, both patients were found to have thrombosed aneurysm of the superficial epigastric vein. During the surgical exploration, both patients were found to have thrombosed aneurysm of the superficial epigastric vein. The superficial epigastric vein was ligated, and the venous aneurysms ( 6 × 4 × 3 and 2 × 3 × 2.5 c m , respectively) were excised. Histological examination of the thrombosed aneurysm showed complete replacement of the vascular wall by fibrous tissue, thrombosis, and an inflammatory reaction. There were no postoperative complications, and both patients were discharged on the second postoperative day. The 3-month and 1-year follow-up examination, respectively, was uneventful. Conclusion. Although venous aneurysms in the inguinal area are rare, they should be included in the differential diagnosis of a groin swelling.

EP.FRI.48 Right iliac fossa pain in females: more than appendixes and ovarian cysts; Haemorrhagic Cyst in the Canal of Nuck: A Case Report

Case report A 43-year-old woman presented with acute onset migratory right iliac fossa pain, on a background of intermittently painful right groin swelling. CT demonstrated differential diagnosis of appendicitis besides an ovarian cyst. Diagnostic laparoscopy was undertaken with a view to diagnosis and treat possible appendicitis, ovarian cyst and inguinal hernia. To our surprise, a haemorrhagic nuchal cyst was seen intraoperatively, and duly aspirated. Post-operatively she recovered well and was discharged the same day. Introduction The Canal of Nuck is a small evagination of parietal peritoneum which accompanies the round ligament through the inguinal canal, in females. It is obliterated in the first year of life. When this remains patent, it can fill with fluid and result in the formation of cysts (akin to hydroceles in patent processus vaginalis). In current literature there are only sixteen case reports of Nuck hydroceles in adults, with only one haemorrhagic cyst reported. These are typically diagnosed in children, but occasionally present in women (aged 35.18 ± 3.27) with groin swelling and are frequently misdiagnosed as hernias. It is only when these woman are taken to theatre, that the correct diagnosis is discovered. Conclusion This case highlights the importance of considering Canal of Nuck cysts when women present with groin swellings, to ensure quick diagnosis and appropriate management is delivered under the correct speciality.

Obstructed right Duari hernia

The caecum and appendix are uncommon contents of femoral hernia (Duari hernia). Diagnosis is usually intraoperative. We report a rare case of obstructed right femoral hernia in a 65-year-old woman. She was admitted into the accident and emergency department because of sudden irreducibility of a previously reducible right groin swelling of 5 years duration. She had obstructive symptoms with an irreducible right groin mass clinically diagnosed as obstructed right femoral hernia. A combination of infra-inguinal transverse incision and a lower midline laparotomy incision was used. The intraoperative findings included the herniation of the caecum and appendix into the right femoral canal. Patient had an uneventful recovery. Duari hernia is uncommon. A high index of suspicion and an experiencedsurgeon, who can handle uncommon findings should be involved in the management of obstructed femoral hernias.

Cytomegalovirus skin disease in a kidney transplant patient

A 44-year-old man with a history of renal transplantation presented with right lower abdominal wall swelling, redness and pain. A bacterial abscess was drained, and he was discharged home with oral antibiotics. After failing to improve, he returned to the hospital, where he was briefly treated with intravenous antibiotics and discharged home again. The patient returned 5 days later, reporting worsening right groin swelling that extended into the ipsilateral scrotum. Imaging revealed a persistent fluid collection in the region, and he was taken for surgical debridement. Tissue immunochemistry and histopathological evaluation identified cytomegalovirus infection. Plasma quantitative PCR for cytomegalovirus demonstrated high viraemia. The patient was successfully treated with intravenous ganciclovir, followed by oral valganciclovir, with resolution of the skin changes. Persistent hydrocele with epididymitis on imaging suggests that this process may have been the source of the cutaneous cytomegalovirus infection.

Isolated Herniation of the Bladder into the Inguinal Canal: A Rare Case Report

Herniation of the bladder towards the inguinal canal is a rare condition. A 76-year-old male patient with long-term left groin swelling was admitted to the emergency clinic complaining of abdominal pain that started about 5 hours ago. The patient, whose abdominal examination was normal, had an incarcerated hernia in the left inguinal region. On superficial ultrasonography, intestinal loop herniation in the left inguinal canal and adjacent loculated fluid of 60x20 mm in size was observed. In the computed abdominal tomography, it was determined that the majority of the bladder had passed through the left inguinal canal and into the hernia sac. Lichtenstein method hernioplasty was applied to the patient who was taken to emergency surgery. Isolated bladder herniation is an extremely rare condition. Recognition of bladder herniation in the preoperative period may prevent possible complications during surgery.

Laparoscopic surgical treatment for hydrocele of canal of Nuck: A case report and literature review

Background Hydrocele of canal of Nuck (HCN) is a rare disease in adult female. The diagnosis and treatment of HCN is still a challenge for surgeons. Case presentation A 56-year-old female presented with recent onset of occasional pain during exercise and an asymptomatic left groin swelling. Ultrasonography results were suspicious for left inguinal hernia incarceration and computed tomography (CT) scan showed no intestinal obstruction, which was considered as HCN. Laparoscopic hydrocelectomy of the HCN and a routine laparoscopic hernia repair via the transabdominal preperitoneal (TAPP) approach were performed. Postoperative pathology showed no malignant lesions or endometriosis. Conclusions The preoperative diagnosis of HCN is extremely important. Surgeons should choose appropriate surgical methods for different anatomical HCNs based on the preoperative diagnosis.

Pantaloon Hernia in a Female: A Rare Finding

The incidence of inguinal hernia in females is less compared to the males. Pantaloon hernia in females is even rarer and may be first diagnosed during surgery. We report a rare case of pantaloon hernia in a 60 year old female patient. She presented with reducible left groin swelling of 3 years duration and a clinical diagnosis of an indirect inguinal hernia made. A direct sac and an indirect sac were discovered at operation on both sides of the inferior epigastric artery. The posterior wall was repaired by Lichtenstein method. Patient made an uneventful recovery and there was no recurrence after 12 months of follow up. Though pantaloon hernia is rare in females, proper dissection, and identification of structure in the inguinal canal is necessary to make the correct diagnosis and to offer the appropriate treatment.