Penopubic testicular ectopia with bilateral cryptorchidism presenting as obstructed inguinal Amyand’s hernia

Testicular ectopia is an aberrant deviation of the migration of the testis from its usual path of descent into the scrotum. Of the forms of ectopic testis, the penopubic (also called pubopenile) type is one of the least common; in this case, presented as an obstructed hernia. We report a rare case of penopubic testicular ectopia with bilateral cryptorchidism in a 17-year-old boy who presented to the emergency room with right obstructed inguinal hernia. Intraoperative findings included bilateral cryptorchidism, hernia sac with right undescended testis and normal vermiform appendix, a left penopubic testis abutting the hernia sac. Both testes had separate epididymides and adequate length of vasa deferentia and were transposed into their respective hemiscrotum via an open inguinal approach. The patient had an uneventful recovery. Penopubic testicular ectopia can present as obstructed Amyand’s hernia. Early open groin exploration with orchidopexy was satisfactory.

Case study: diagnosis and operative management of de Garengeot hernia without appendectomy during the COVID-19 pandemic

de Garengeot herniae have been reported in <100 cases in literature. They are characterized by an incarcerated femoral hernia containing the appendix. We present the case of a 45-year-old female who, upon emergency intraoperative consultation to a general surgeon while having a right groin exploration by a plastic surgeon, was found to have an appendix incarcerated within a femoral hernia. There was no evidence of appendicitis; thus, appendix was reduced and the hernia was repaired with a mesh plug. The patient did well postoperatively, with no complications and returned to complete activities. This occurred during the coronavirus disease (COVID-19) pandemic. Due to the common failure in preoperative diagnosis, it is important for surgeons to have a clinical suspicion for de Garengeot herniae for patients, presenting with a right groin bulge. Appendectomy may be safely avoided, eliminating appendectomy-associated morbidity and avoiding hospital transfer and the associated risk of COVID-19 exposure.

Symptomatic attachment of appendix vermiformis following a plug inguinal hernia repair

We describe a case of attachment of an appendix vermiformis following an inguinal hernia plug repair according to Rutkow and Robbins. A 62-year-old man presented at our outpatient clinic with a progressive sensation of tightness in the right groin area, painful urge of miction and long-lasting nausea with abdominal discomfort. During an open groin exploration, the appendix was found attached to an intraperitoneally located plug. The appendix and plug were removed with an uneventful recovery. During follow-up, the patient was free of groin pain and miction had normalised. Surprisingly, his long-lasting nausea and abdominal discomfort had disappeared as well.

Timing and Management of Inguinal Hernia in the Premature Baby

Inguinal hernias in children occur with a prevalence ranging from 3 to 5%. The likelihood of a symptomatic patent processus vaginalis is significantly higher in preterms, as reported by most series. As a consequence, inguinal hernia represents the most common condition requiring surgical repair in the neonate and preterm baby. Surgery aims at avoiding and preventing intestinal and gonadal lesions related to incarceration. Nonetheless, hernia repair is technically demanding, with a relatively high risk of complications including recurrence and testicular atrophy. This paper will address some of most debated aspect of inguinal hernia management in preterms babies. The authors will discuss anesthesiological implications, available surgical techniques, optimal timing for surgery, and reasons for possible contralateral groin exploration. The authors will also discuss literature evidences and will propose their own behavior to provide an algorithm for the correct management of neonates and ex-preterms with inguinal hernia.

Three Years Experience of Inguinal Hernia in Children in BSMMU

Objective: The aim of this study is to evaluate the management of inguinal hernias in children as a day case surgery in elective basis.Methods: From July 2011 to June 2014, 141 infants and children with inguinal hernias were seen, operated on, and followed up as outpatient procedure in the Department of Paediatric Surgery of Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh (BSMMU) Age, sex, side of hernia, presence of an associated hydrocele/ undescended testes/ VPshunt, occurrence of contralateral hernia, clinical aspects of these patients, type of surgery, mortality, and mobidity were studiedResults: The ages ranged from 2months to 14 years (mean age, 6.28 years) with a male-to female ratio of 3:1. There were 59.6% right, 34.8% left, and 5.7% bilateral hernias (all are indirect variety).The most common associated anomaly was hydrocele in 29(20.8%)patients, undescended testis in 9(6.5%) patients and in 4(2.8%) patients had ventriculoperitoneal shunt. The content of the hernial sac in 56(39.7%) patients were omentum and next were intestine in 30(21.3%) patients. Overall, there were 13 (9.2%) sliding hernias. Among them in five case of boys four (80%) patients contents were cecum and one (20%) patient was sigmoid colon. In case of girls, contents were ovaries in all eight patients. Contralateral groin exploration was not done of any patients at the initial hernia repair. There were recurrences in 2(1.4%) patients, 13(9%) patients developed wound infections, and 21(15%) patients had scrotal haematocele. There were no postoperative deaths. A contralateral hernia developed in three (2%) children within one year after the initial repair.Conclusions: Inguinal hernia is a common surgical condition in children. Elective surgery is associated with minimal morbidity. A routine contralateral groin exploration is not done at the initial hernia repairJ. Paediatr. Surg. Bangladesh 6(2): 34-38, 2015 (July)

Ovarian Mass Causing Paradoxical MI and Leg Ischaemia

Paradoxical embolus through a patent foramen ovale is a well-reported phenomenon. Clinical consequences include stroke, intestinal infarction, lower limb ischaemia, and even acute myocardial infarction (MI), via embolisation to the coronary arteries. We present a case of acute MI, cardiogenic shock, and cardiac arrest caused not by this mechanism, but by embolisation of thrombotic material to the aortic root with transient complete occlusion of the left main stem (LMS) coronary artery. During percutaneous coronary intervention to treat this occlusion the thrombus became lodged at the aortic bifurcation causing lower limb ischaemia. Despite successful treatment of this via bilateral groin exploration and thromboembolectomy the patient became increasingly acidotic and an abdominal and pelvic CT scan was performed. This revealed the source of the thrombus to be the patient’s congested and compressed pelvic veins which were the result of a large, previously undiagnosed ovarian malignancy with metastatic spread. Although very unusual we feel this case highlights an important differential in the diagnosis of anterolateral MI and images similar to those presented here are previously unreported in the literature.