Gaint Inguino Scrotal Hernias -A Rarity In Today’s Era

By Dr. Abhijit Musale | Dr.Vaishali Gaikwad | Dr. R. M. Kulkarni

Transcript

1. GAINT INGUINO SCROTAL HERNIAS - A RARITY IN TODAY’S ERA Dr.Abhijit Musale Dr.Vaishali Gaikwad Dr.R.M.Kulkarni
2. CASE 1  39 yr old/m came with large swelling in right inguino-scrotal region gradually increased over 9 years. difficulty while walking. No h/o urinary complains. Completed family
3. Clinical Examination O/E: - globular swelling of 28X18X20cm extending from right inguinal region up to the knees with buried penis, dilated veins - soft, non reducible, non tender swelling, testis palpable at base, - peristalis at ascultation - suggesting enterocele and omentocele.
4. Investigations CBC - 13.0 / 6700 / 245000 Sr. Urea / creatnine - 31.0 / 0.8 Urine r/m - WNL USG - Right hydrocele with inguinoscrotal hernia.
5. Intra-operatively 3 cm indirect hernial defect combined Amyand’s and Litter’s hernia Enterocele Omentocele noted.
6. He underwent appendectomy, diverticulectomy, orchidectomy, hernia reduction and hernioplasty with uneventful recovery and follow up.
7. 2 month later
8. CASE 2  A 65 yr male presented with swelling in bilateral scrotal region since 7 years  difficulty in walking and to urinate.
9. Clinical Examination  O/E: Rt. scrotal region: swelling of size 25X18X17cm from right inguino- scrotal region beyond mid thigh, partially reducible suggestive of enterocele and omentocele. Lt. scrotal region: swelling of size 12X10X10cm, cystic, fluctuant with transillumination.
10. Investigations  CBC - 13/ 7000/ 293000  Sr. Urea / Creatinine - 28.4/ 1.1  Urine R/m - WNL  USG: - Rt. inguino-scrotal hernia and Lt. sided hydrocele
11. Intra-operatively- 4 cm indirect hernial defect Enterocele  omentocele left side a hydrocele was noted.
12. He underwent reduction of hernia with hernioplasty on right side left side hydrocele repair uneventful recovery and follow up.
13. REFERENCES: 1. E Coetzee, C Price and A, boutall; Simple repair of a giant inguinoscrotal hernia; Int J Surg Case Rep. 2011; 2(3): 32–35;  PMCID: PMC3199728 2. E Tay, E Gray and M W Morgan; Repair of a massive inguinal hernia; J R Soc Med. 1999 November; 92(11): 586– 587.  PMCID: PMC1297438 3. Mohammad Tahir, Faiz U. Ahmed, V. Seenu; Giant inguinoscrotal hernia: Case report and management principles;  International Journal of Surgery Volume 6, Issue 6, December 2008, Pages 495–497.
14. Discussion Giant inguinoscrotal hernias are uncommon. They are defined as hernias that extend below the midpoint of the inner thigh in the standing position. They present a new spectrum of problems for patients apart from the classical complications of inguinoscrotal hernia. Patients encounter difficulties in walking, sitting or simply lying down, and their mobility is dramatically restricted. Often develop gangrene and ulcers of the scrotal skin. May present with acute retention of urine due to voiding difficulties as the scrotum tightens around the penis. Also develop fatal tissue expansion of vascular pedicles.
15. TAKE HOME MESSAGE  An early surgical intervention and hernia repair is the necessity to avoid complications and morbidity of patient.  Adequate pre-operative planning as well as intra-operative and postoperative monitoring is essential.  Patient’s awareness towards this treatable condition and early diagnosis forms a vital aspect for the management of giant hernias. Thank You !!
16. Thank you