A constricting ring structure within the wall of the inguinal hernia sac in infants and children and its role in the occurrence of incarceration

Abstract

The study aims to demonstrate the presence of a fibrous or fibromuscular ring structure within the wall of the sacs of inguinal hernia in children and its importance in the development of incarceration as a direct cause of this complication. A case series study of 784 children with unilateral inguinal hernias operated on over a period of 9 years (1992-2000) in two teaching hospitals (Mosul, Iraq). All underwent herniotomy. The sacs were examined for the presence of a ring structure, and the excised sacs containing the rings were studied histopathologically. The presence of the hernia sac ring (HSR) and its significance in the causation of incarceration was studied. Out of 784 cases, 660 were elective and 124 incarcerated hernias. In 56 sacs the hernia sac ring (HSR) was present - 36 rings in the elective and 20 rings in the sacs of incarcerated hernias. The histopathology of the hernia sac ring was fibrous or fibromuscular tissue. This ring has its significance in the development of incarceration. Hernias with the HSR are three times more liable to incarceration than those without the ring. Incarcerations of inguinal hernia in children are usually caused by the inguinal rings. Another cause for incarceration being studied is a fibrous or fibromuscular ring structure identified within the wall of the hernial sac, causing the incarceration in 5.6% of elective (nonincarcerated) hernias and 16% of incarcerated hernia patients. Patients with these hernia sac rings are three times more liable to incarceration than others.