Unusual findings in inguinal hernia surgery: report of 6 rare cases

Abstract

Background and aim: To present our experience with unexpected findings during hernia surgery, either unusual hernial contents or pathologic entities, like neoplastic masses, masquerading as a hernia.

Patients and methods: We studied retrospectively 856 patients with inguinal hernia who were admitted to our surgical department over a 9-year period. In addition, our study included patients complaining of inguinal protrusion, even without a definitive diagnosis of inguinal hernia upon admission.

Results: Five patients presented with unusual hernial contents. Three of them had a vermiform appendix in their sac. Acute appendicitis (Amyands hernia) was found in only one case. One patient had epiploic appendagitis related with a groin hernia. Moreover, an adult woman was diagnosed with ovarian and tubal inguinal hernia. Finally, we report a case of a massive extratesticular intrascrotal lipoma, initially misdiagnosed as a scrotal hernia.

Conclusion: a hernia surgeon may encounter unexpected intraoperative findings. It is important to be prepared to detect them and apply the appropriate treatment.

Keywords: Amyand's hernia; epiploic appendagitis; inguinal mass; intrascrotal lipoma; ovarian and tubal hernia.

Figure 1:. An inflamed appendage epiploica of the sigmoid colon, as a hernia sac content

Figure 2:. Ovarian and tubal inguinal hernia in an adult patient

Figure 3:. Massive intrascrotal extratesticular lipoma

Figure 4:. Massive intrascrotal extratesticular lipoma. The removed specimen