"Uncommon Contents of Inguinal Hernial Sac": A Surgical Dilemma

Abstract

Inguinal hernia repair is the most common surgery done by both young and experienced surgeons. The hernia in the inguinal region usually contains the omentum and small intestine but rarely can contain unusual contents like the appendix, ovary with fallopian tubes, urinary bladder, sigmoid colon, and cecum. The aim of this study is to present our experience of uncommon contents in the inguinal hernia sac and their surgical management. A retrospective study of 330 patients who underwent inguinal hernia repair was carried out over a period of 3 years from January 2008 to December 2011. Only five patients presented with unusual contents in the inguinal hernia sac; an incidence of 1.5 %. Two of them had vermiform appendix, with acute appendicitis (Amyand's hernia) noted in one of them. The patient with acute appendicitis underwent appendicectomy with herniorrhaphy, while in the other, hernioplasty with mesh was done as the patient was with normal appendix. In one case, the urinary bladder was the content of the inguinal hernia sac and there were two cases with the ovary and fallopian tubes as its content. In all these cases, contents were replaced back and hernia repair was done. Unusual contents of the hernial sac may create a surgical dilemma (whether to save or sacrifice the organ) during hernia repair even to an experienced surgeon.

Keywords: Amyand’s hernia; Appendix; Inguinal hernia; Ovary.

Fig. 1

Inflamed appendix in the hernial sac

Fig. 2

Normal appendix in the hernial sac

Fig. 3

Edematous bulky ovary with congested fallopian tubes

Fig. 4

Hernia of the canal of Nuck up to the labia

Fig. 5

Urinary bladder as the contents of the right direct inguinal hernial sac