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A 35 year female presented with gradually increasing swelling in inguinal region of 8 years which was painful during menses. On systemic examination no significant disease was noted. On local examination right inguinal region showed soft tissue nodular mass measuring 3x1.5x1cm.On ultrasonography showed soft tissue nodule suggestive of vascular lesion. Minimal pericapsulitis was noted .No abscess or necrosis was noted. Lesion was surgically excised and sent for histopathology. Grossly received single oval lymph node measuring 2.5x2x1 cm. Cut section was dark grey brown with areas of hemorrhages. On histopathology diagnosed as Capillary Cavernous Hemangioma of right inguinal lymph node. We are presenting this case for its extreme rarity, its clinical, radiological, histopathological presentation. Recognizing these vascular lesion entities in lymph node is essential to for diagnosis and to guide therapy. Key words: Intranodal tumor, Inguinal lymphadenopathy, Nodal hemangioma.

Background: Iliopsoas bursal cystic lesion (IBCL), a rare disease on groin area, posing a significant threat to the lower limb thrombosis, but it is easy to misdiagnose or missed diagnose. Doppler ultrasonography (DU) with certain advantages could be used to detect the enlarged iliopsoas bursa (EIB) and compression of lower extremity vein. Case presentation: A 60-year-old man was admitted to our department complaining of pain and swelling in his right groin area for 3 weeks. DU demonstrated that there was a well-defined, echo-free, cystic mass in the right inguinal region, which severely compressed the common femoral vein (CFV), and the blood flow velocity was extremely slow. Then, surgery was performed to exclude the lesion, consequently, corresponding signs and symptoms had resolved completely. Histopathological results suggested the mass is an iliopsoas bursa filled with mucinous materials. After that, DU was displayed again and the results suggested that the EIB has almost been excised and there was a slight echogenic structure in the deep layer communicating to the hip joint space. Conclusion: Although, IBCL is rare and easy to misdiagnose and missed diagnose, the DU with certain advantages could be used to diagnose effectively this disease and guide the clinical prevention and intervention of thromboembolic events.

Se describe a la Hernia de Amyand como la presencia del apéndice cecal dentro de un saco herniario inguinal con un proceso inflamatorio-Infeccioso o no, cuya frecuencia

A 7-year-old girl was referred to our hospital with a suspected right-sided indirect inguinal hernia. An egg-sized elastic, non-painful mass was palpated in the right inguinal region. Preoperative CT demonstrated a 30-mm simple cystic mass in the right internal inguinal canal, which we diagnosed as an abdominal cyst of the canal of Nuck. Laparoscopy revealed that the abdominal cystic component was ruptured, so we performed Pott's procedure. However, the patient's right groin swelled on postoperative day 3, necessitating re-operation. The patient's symptoms recurred again after 3 months, despite having had two surgical repairs. In the third operation, a right-sided femoral hernia was confirmed and repaired via external and laparoscopic approaches. To the best of our knowledge, there have been no reports on the combination of femoral hernia and cyst of the canal of Nuck in children. A laparoscopic approach was useful for obtaining a definitive diagnosis and conducting a safe and secure surgical repair.

Delayed deep mesh infection is a rare complication and the precise mechanism of its development is unknown. We report a case of delayed deep mesh infection after inguinal hernia repair. A 65-year-old man was admitted for treatment of colon cancer. He had a history of bilateral hernioplasty repaired with mesh-plugs 6 years previously. Fluorine-18 fluorodeoxyglucose positron emission tomographic scan showed positive findings in the right inguinal region similar to cancer. He had no complaints or findings to suspect mesh infection. Postoperative computed tomography scan over time revealed a fluid collection with inflammation. Eleven years after hernia repair, the patient presented with inflammation in the right inguinal region and emergency operation was performed. An abscess cavity was found and the mesh-plug covered with granulation tissue was removed. The patient remains free of recurrence of inguinal hernia or inflammatory changes after 3 years of follow-up.

A 64-year-old woman with metastatic papillary thyroid cancer underwent a total thyroidectomy followed by 2 courses of 131I therapy. The posttherapeutic whole-body scan after the second dose of 131I therapy showed multifocal bone metastasis. In addition, there is focal abnormal intense radiotracer uptake at the right inguinal region. SPECT/CT revealed that this abnormal focal radioactivity was from a superficial skin lesion. Further physical examination revealed a raised, approximately 1-cm, irregular grayish-brown lesion on the right groin skin. Histopathological examination confirmed the diagnosis of basal cell papilloma (seborrheic keratosis).

Introduction: Amyand’s hernia is an extremely rare and atypical hernia that is difficult to diagnose clinically characterized by the herniation of the appendix into the inguinal sac. The aim of this report is to describe a case of Amyand’s hernia and highlights the importance of early CT scanning in reaching the exact and early diagnosis of Amyand’s hernia. Case report: We present a rare case of a 69-year-old female patient with a history of intermittent pain in the right inguinal region is see at the emergency surgical clinic. The patient underwent a CT scan of the abdomen and a small pelvis, and an inflamed appendix was diagnosed. The inflamed appendix is herniated in the inguinal hernia sac. Computed tomography was the only modality to diagnose the hernia sac contents preoperatively. Discussion: The reported incidence of Amyand’s hernia is less than 1% of all adult inguinal hernia cases. Acute appendicitis in Amyand’s hernia is even less common, with 0,1% of all cases of acute appendicitis. This hernia may be present without symptoms until the inflammation of the appendix may lead to incarceration, strangulation, necrosis, perforation, or rupture. Early symptoms include tenderness and inguinal swelling. Conclusions: Computer tomography helps make an accurate and timely diagnosis of Amyand’s hernia, thus avoiding complications from delayed surgery.

Inguinal hernia is the most common type of groin hernia in females. In comparison, complete androgen insensitivity syndrome (CAIS) is a rare genetic disease that can present with an inguinal swelling containing testis in a female. We report a case of a 42-year-old phenotypic female who presented with swelling in the right inguinal region and primary amenorrhea. The swelling showed impulse on coughing, and working diagnosis of incarcerated hernia was made. Investigations revealed the absence of uterus, cervix, and fallopian tube with presence of right ovary in right inguinal canal and left ovary in intra-abdominal region. Chromosome analysis revealed XY karyotype, thereby confirming the diagnosis of CAIS. On exploration, firm testis-like structure was detected in the right inguinal canal, and gonadectomy with herniotomy was done. However, opposite side gonadectomy was refused by the patient. Histopathologically, excised mass showed atrophic testis with sertoli cell adenoma.

History A 2-year-old sexually intact male Vietnamese potbellied pig that weighed 113 kg (249 lb) was admitted and examined to determine the cause of inappetance, irritability, and an enlargement in the inguinal region. The clinical signs had become more evident and the pig’s condition had gradually worsened during the preceding week. No treatment had been initiated prior to our examination. The owners reported that the boar would attempt to mate with a piece of polyvinyl chloride pipe. Physical examination revealed massive distention (40 X 25 cm [15.7 X 9.8 inches]) in the inguinal region and caudoventral portion of the abdomen. Palpation of the enlargement revealed it was firm and excessively warm but could be compressed, which suggested it was filled with fluid. The prepuce was edematous. There was evi dence of irritation of the skin over the right inguinal region. Question

Highlights • We present a very rare case of advanced ovarian cancer. • This is the first report of metastasis to a hydrocele in the canal of Nuck. • Ovarian cancer can metastasize to a hydrocoele in the canal of Nuck in adult women., Introduction Ovarian cancer has few subjective symptoms, so approximately 40%–50% of cases have already reached stage III or IV by the time of diagnosis. These are advanced stages of the disease and have poor prognosis. Among these cases, less than 3 % are reported to exhibit inguinal lymph node metastasis. This report documents a rare case of advanced ovarian cancer that we detected due to an inguinal metastasis in the canal of Nuck. The work has been reported in line with the SCARE criteria. Presentation of Case The patient was a 43-year-old, married, premenopausal woman (G2P1). She was examined by her local practitioner for a chief complaint of a mass in the right inguinal region and was found to have a right inguinal mass. Magnetic resonance imaging (MRI) scans revealed a left ovarian tumor, and she was referred to our department. Rapid intraoperative diagnosis showed a highly atypical serous carcinoma present in both the left ovary and the right inguinal region mass, where the tumor had extended into the canal of Nuck. Discussion In this case, the right inguinal mass was ovarian cancer that had metastasized to a cyst in the canal of Nuck via the round ligament of the uterus. Though, many adult women with these types of inguinal hydrocoeles sometimes undergo fine-needle aspiration. Conclusion This finding may highlight the need for a careful search for metastasis to the inguinal region in cases of ovarian cancer.

Highlights • In crossed testicular ectopia both testes are migrated and descend through a single inguinal canal. • Inguinal hernia is always present in the affected side. • The diagnosed is usually done during surgery., Background Crossed testicular ectopia is a rare form of urogenital anomalies in which both testes are migrated and descend through a single inguinal canal, one or both testes may be ectopic in the abdomen, the inguinal region or descent to the hemi-scrotum with empty contralateral hemi-scrotum. Case presentation A 1.5-year-old male patient had an empty left scrotum with no palpable testis in the inguinal region with a palpable testis in the right scrotum with palpable other testis in the right inguinal region. Ultrasound examination showed the right testis in the right scrotum and another testis measuring in the right inguinal region giving suggestion of both testes in the right side. During operation two testes was found in the right inguinal region with two small indirect inguinal sacs. Herniotomy was performed for both sacs. The right testis was placed and fixed in the right hemi-scrotum and the left testis was fixed in the left hemi-scrotum through trans-septal window. Conclusion During surgery, the surgeon should adopt a conservative approach to preserve the fertility. Trans-septal orchiopexy or extra-peritoneal transposition orchiopexy is advised. In case of persistent Müllerian duct syndrome, preservation of the Müllerian remnants is recommended to preserve blood supply to the vas deferens and testis. Karyotyping may be required in some cases specially if associated with other congenital anomalies of the genitalia. Patients usually need long term follow up because such patients may have future fertility problems and there is an increased risk of the development of testicular cancer.

The purpose of this study is to introduce and evaluate a modified surgical approach to induce acute ischemia in mice that can be implemented in most animal laboratories. Contrary to the conventional approach for double ligation of the femoral artery (DLFA), a smaller incision on the right inguinal region was made to expose the proximal femoral artery (FA) to perform DLFA. Then, using a 7-0 suture, the incision was dragged to the knee region to expose the distal FA. Magnetic resonance imaging (MRI) on bilateral hind limbs was used to detect FA occlusion after the surgery. At 0, 1, 3, 5, and 7 days after the surgery, functional recovery of the hind limbs was visually assessed and graded using the Tarlov scale. Histologic evaluation was performed after euthanizing the animals 7 days after DLFA. The procedures were successfully performed on the right leg in ten ApoE-/- mice, and no mice died during subsequent observation. The incision sizes in all 10 mice were less than 5 mm (4.2 ± 0.63 mm). MRI results showed that FA blood flow in the ischemic side was clearly blocked. The Tarlov scale results demonstrated that hind limb function significantly decreased after the procedure and slowly recovered over the following 7 days. Histologic evaluation showed a significant inflammatory response on the ischemic side and reduced microvascular density in the ischemic hind limb. In conclusion, this study introduces a modified technique using a miniature incision to perform hind limb ischemia (HLI) using DLFA.

Background: Inguinal lymph node dissection is performed in penile cancers and has a high complication rate with mostly wound-related complications. This case study demonstrates the use of robotic technique, tissue perfusion assessment, and negative pressure wound dressing to minimize wound-related complications. Case Presentation: A 67-year-old Maltese man was diagnosed with squamous cell carcinoma (SCC) in situ on biopsy of a self-detected penile lump. The patient underwent a partial penectomy and histopathology report confirmed moderately differentiated SCC with clear surgical margins. A positron emission tomography/CT scan was performed preoperatively, which showed several nodes in the right inguinal region with increased metabolic activity and nonspecific findings in the left inguinal region. The patient had a robotic right inguinal node dissection the following month. Assessment of the skin flap was performed using indocyanine green (ICG) angiography with the SPY system and there was excellent vascularity. Further treatment was performed 3 months later with a robotic left inguinal node dissection. Again, assessment of the skin flap was performed using the SPY system but showed an area of poor perfusion in the left femoral triangle, which suggested a high risk of inadequate wound healing and tissue necrosis. The clinical decision to use the negative pressure PICO dressing was made intraoperatively to enhance perfusion of the skin. When the PICO dressing was removed it revealed excellent tissue viability and vascularity of the skin flap. Histopathology analysis showed no evidence of malignancy in the nodes removed and patient was discharged to the outpatient care of their urologist. Conclusion: This case study demonstrates that the use of a tissue perfusion assessment tool avoided a potentially poor clinical outcome for the patient. Robotic inguinal lymph node dissection was performed in coordination with ICG angiography to guide the use of negative pressure wound therapy and facilitate good wound healing.

Background - Systemic diseases like diabetes, hypertension etc are at higher risk of perianal diseases. A complex anal fistula, which is associated with diabetes are high complication rates and healing impairments. Treatment of fistula in ano depends on the location of the fistula, amount of anal sphincter involved in the fistula, and the underlying disease process. Prevention of recurrence and controlling the purulent discharge by surgical method are the definitive treatment of fistula in ano. Here, we present a complex case of Fistula in ano in uncontrolled diabetes mellitus patients which as an extension towards right iliac region and right inguinal region which was treated by surgical intervention. Case presentation – a thirty-year-old diabetic male patient come to us for recurrent fistula in ano with swelling at right iliac and inguinal region. We do surgical intervention and discharged on 9th post operative day. A follow up examination of post operative wound was taken after 2 days interval respectively. After 3 months, fistula track was completely healed. Conclusion: fistula in ano is a complex disease in diabetic patients and imposes challenges to the surgeon. Early diagnosis and appropriate management is the key to success. Proper assessment and mapping of the tract is very important before going in for a definitive surgery.

La hernie de Amyand se definit par l'incarceration de l'appendice vermiculaire dans le sac herniaire. Elle constitue une entite rare. Nous rapportons le cas d’un patient de 75ans, ethylique, denutri et porteur d’une cardiopathie ischemique stente et sous traitement anticoagulant, admis pour une tumefaction douloureuse et chaude localisee en region inguinale droite evoluant depuis cinq jours. Le bilan biologique revelait un syndrome infectieux et des troubles severes de l’hemostase. Le scanner a objective un appendice perfore au sein du sac herniaire droit et un thrombus intraventriculaire gauche. L’evolution s’est faite vers une gangrene de Fournier. Apres correction des troubles hemostatiques, la prise en charge chirurgicale a consiste en l’appendicectomie, drainage par laparotomie mediane associee a une orchidectomie droite sur un testicule necrose avec exerese jusqu’en zone saine de la peau scrotale. Malgre des constantes stables en per-operatoire, le patient a presente un arret cardiaque en post-operatoire immediat, reanime sans succes. Amyand hernia is defined by the presence of appendix herniating into the deep inguinal ring. It’s a rare condition. We report the case of a 75-yearold male patient, presenting alcoholism, undernutrition and ischemic cardiopathy which required angioplasty and anticoagulation, admitted for a painful and hot swelling in right inguinal region evolving for five days. Blood analysis revealed infectious syndrome and important hemostasis disorders. Computed Tomography scan showed perforated appendix herniating through inguinal ring associated to a thrombus in the left ventricle. The evolution was marked by a Fournier’s gangrene. After getting the normalization of the hemostasis values, a laparotomy was performed for appendicectomy, drainage. The right testicle, necrotized, was removed, with a wide debridement of the fasciitis. Although the parameters were stable during the surgery, the patient presented

Highlights • Uterine inguinal hernia should be considered in the differential diagnosis of inguinal masses in women of child-bearing period. • The diagnosis of uterine inguinal hernia in women of childbearing age is often combined with congenital genital malformations. • Many methods including intraoperative laparoscopic exploration are helpful for diagnosis., Introduction Inguinal hernia encompassing the uterus, ovary and fallopian tube are uncommonly present in women of reproductive age, which is often diagnosed and treated during childhood. In this article we report a case of uterus inguinal hernia accompaniment didelphys uterus were confirmed during surgery. Presentation of case A 15-year-old female presented with a history of a reducible mass located in the right inguinal region. Surgery was performed through an inguinal approach and the entire infantile uterus, both ovary and fallopian tube were found within the hernia sac. Laparoscopic exploration confirmed a normal uterus in the pelvic cavity, and the patient was discharged 3 days after the Lichtenstein operation. Discussion Although inguinal herniation is a common condition that occurs most often in elderly male and without any associated clinical symptoms. But uterine inguinal herniation should be considered as a reducible mass showed in the inguinal region. For open surgery, laparoscopy can be clearly diagnosed if it’s necessary to avoid blindly cutting and ligating important structures, which may affect fertility function after operation. Conclusion Before the final choice of treatment is made, digestive surgeons should bear this rare hernia of uterine in mind for the differential diagnosis of an inguinal masses in women of child-bearing period. Congenital deformity genital organ, meanwhile, also should be considered.

Leukemic phase of malignant lymphoma is a group of lymphoid malignancies typically localized in lymph node and present typical clinical features such as lymphadenopathy with irregular distribution. It can manifest as an extranodal disorder infiltrates the bloodstream (leukemic phase). Lymphomas are differentiated into Hodgkin and non-Hodgkin. The presentation of Reed-Sternberg (RS) cells in histological evaluation establishes Hodgkin lymphoma. A number of classification systems have been used before the publication of Revised European American Lymphoma (REAL) classification in 1994 which includes all lymphoid and lymphoma malignancies according to typical histology, morphology, immunophenotype, genetic, and clinical manifestation. A highly proliferative and fatal malignant lymphoma with leukemic phase case in 13 years and a one-month-old male was reported. The diagnosis was established based on marble-sized lymph nodes enlargement that increased in size, two weeks after initial identification on the neck, head, and inguinal regions and followed by lymphadenopathies in submental, right submandibular, preauricular and right inguinal region. No fever history of this patient or malignant history among his family was found. Laboratory findings included WBC of 26,050/µL, Hb 9.6 g/dL, and PLT 16,000/µL. Peripheral blood smear results indicated suspected leukemic phase of malignant lymphoma DD/ALL. Bone marrow aspiration showed leukemic-phase of malignant lymphoma with bone marrow infiltration. Cytological evaluation of Fine Needle Aspiration (FNA) identified atypical round nucleated cells with nucleus size mostly larger than the mature lymphocytes, minimum cytoplasm, diffuse erythrocyte as background, a conclusion was malignant lymphoma.

Aim: To study the characteristics and surgical treatment of inguinal endometriosis (IEM), which can occur in women of reproductive age. Methods: Patients who underwent groin surgery at the Hiroshima City Funairi Citizens Hospital between 2004 and 2017 were retrospectively examined. Patients with IEM were divided into 3 groups based on the site of occurrence as follows: at a hernia sac or hydrocele of Nuck’s canal (type I), round ligament (type II), or subcutaneous area (type III). Clinical characteristics were compared among groups. Results: Of 2,798 patients investigated, 28 were pathologically diagnosed as having IEM with 15, 10, and 3 classified as type I, II, and III respectively. All patients presented with a mass (median 20 mm) and/or bulge that mainly occurred at the right inguinal region. Sixteen patients presented with inguinal pain associated with menstruation. While the groups did not differ in terms of most clinical characteristics, the lack of a preoperative diagnosis of IEM occurred more frequently for type I than for types II and III. Conclusions: Because IEM-type I might be underdiagnosed preoperatively, complete resection of a hernia sac or hydrocele of Nuck’s canal with subsequent pathological examination is required for women of reproductive age with an inguinal disease.

Meckel’s diverticulum (MD) is the persistence of the omphalomesenteric duct. It is usually asymptomatic but may present with bleeding, infections, and intestinal obstruction. It also may be a content of a hernia sac, a so-called Littre hernia. Herein, we will present the case of a 75-year-old female, who suffered from a painful swelling of the right inguinal region. Ultrasound imaging detected an inguinal hernia with incarcerated blind ending small bowel. Immediately, a laparoscopy was conducted. We diagnosed a right femoral hernia with an incarcerated MD. A TAPP (transabdominal preperitoneal) procedure was performed and the MD tangential stapled. Due to an uneventful postoperative course, the patient left the hospital after two days. An incarceration of a MD in a femoral hernia is rare. Tangential resection of the MD with simultaneous hernia repair in a TAPP technique seems to be a sufficient approach, when it is conducted by an experienced surgeon.

Persistent mullerian duct syndrome (PMDS) is usually an accidental finding during routine inguinal hernia repair in male patients. Intraoperatively, mullerian remnants consisting of an infantile uterus and fallopian tubes are usually found. Herein we report a case of PMDS in a 3-year-old boy presenting with unilateral undescended testes.The right testis was not palpable and the diagnostic ultrasound shows a non-visualized right testis neither in scrotum nor in the right inguinal region.

Hydrocele of the canal of Nuck also called the “female hydrocele” is a rare entity in females. The processus vaginalis peritonei is a tubular fold of peritoneum that invaginates into the inguinal canal along with the round ligament. It usually gets obliterated by birth or during early infancy, but if this communication remains patent, it may lead to the development of an indirect inguinal hernia or hydrocele. Here, we present the case of a 32-year-old female who complained of swelling in the right inguinal region. Contrast-enhanced computed tomography scan of abdomen and pelvis was suggestive of a cystic lesion in the right inguinal region which was seen extending from mons pubis up to the right iliac fossa in the retroperitoneum likely suggestive of hydrocele of the canal of Nuck. Surgical excision of the cyst was done.

Introduction and importance Primary testicular lymphoma (PTL) is a variety of extra-nodal lymphoma taking origin from testis. It accounts 5% of all testicular tumors. Metastasis may occur in contralateral testis, bone, central nervous system and rarely in skin. Herein, we present the case of testicular diffuse large B-cell malignant lymphoma with cutaneous metastasis. Case presentation A 60-year-old male presented with swollen painless solid right testis, with homolateral inguinal nodes. Testicular tumors markers were within normal range. Right radical orchidectomy was performed. Histopathological examination concluded to the diagnosis of Diffuse Large B Cell Lymphoma. Four weeks later, the patient presented alteration of general condition and multiples cutaneous centimetric lesions located in the right inguinal region. Biopsy of this lesion confirmed the diagnosis of metastases from the testicular lymphoma. The patient deceased three days later, before starting further treatment. Clinical discussion Primary testicular lymphoma is a rare variety of testicular tumors. The prognosis is poor. Metastasis may occur in different sites such as contralateral testis, central nervous system, and skin. The prognosis is usually poor in the rare case of cutaneous metastasis. Conclusion Primary testicular tumor is an aggressive rare variety of testicular tumors with poor prognosis. Cutaneous metastasis is rarely reported. Cutaneous lesions should be explored and suspected to be malignant. Early treatment with rapid multidisciplinary management is the key for adequate approach., Highlights • Primary testicular lymphoma is rare, aggressive testicular tumor. • Skin metastasis is extremely rare, and if present, compromises the prognosis. • Diagnosis may be comforted by 18F-PET-CT. • Orchidectomy followed by chemotherapy is the recommended therapeutic options.

Highlights • It may be beneficial for patients with type 2 Amyand’s hernia to have an appendectomy with a tension free hernia repair using mesh. • Controversies still exist regarding the recognized classification system and treatment algorithm of Amyand hernia. • Controversy exists regarding the use of mesh for the treatment of type 2 Amyand’s hernia however we add to the argument of pro-mesh., Introduction An Amyand hernia is a rare disease where the appendix is found within an inguinal hernia sac. This rare entity is named after the French born English surgeon, Dr. Claudius Amyand. Inguinal hernias are one of the most common surgeries that a general surgeon performs with more than 20 million inguinal hernia repairs performed yearly worldwide. The incidence of finding an appendix within the hernia sac is rare, occurring in less than 1% of inguinal hernia patients and when complications arise such as inflammation, perforation, or abscess formation it becomes exceptionally rare with an incidence of about 0.1%. Presentation of case A 59-year-old male with a history of a previously reducible right inguinal hernia presented to the Emergency Department with acute abdominal pain, right groin mass. Computed tomography (CT) confirmed a right incarcerated inguinal hernia with herniated loops of bowel within the right inguinal region. Patient was subsequently treated with an appendectomy and tension free hernia repair with mesh with a successful outcome. Discussion The current generally accepted treatment algorithm for Amyand’s hernia is essentially contingent on the appendix’s condition within the hernia sac. Controversy exists regarding the application of mesh in type 2 Amyand’s hernia. More research is needed to provide surgeons with evidence-based standardized approaches for dealing with this unique situation. Conclusion This case report reviews a rare entity known as an Amyand’s hernia that presented as an incarcerated hernia that was diagnosed intraoperatively with an inflamed appendix, recognized as a type 2 Amyand’s hernia.

Amyand’s hernia is described in the inguinal hernia sac as being the presence of an appendix vermiformis . It is a rare condition the incidence is about 1 per cent of all inguinal hernias. It is often diagnosed incidentally during inguinal hernia surgery. The main treatment method of Amyand’s hernia is surgery. We report a case of 63 years old man who presented with right inguinal groin bulge for 1 month with the previous repaired right inguinal hernia 5 years ago. On clinical examination revealed a 6 cmx8 cm firm, nontender, irreponible mass in the right inguinal region. He was diagnosed as right sided irreponible inguinal hernia. He was undergoing the elective surgery. Intra-operative, the hernia sac was laterally found in the inferior epigastric vessels and separated from sperm cord to deep inguinal ring. The hernia sac was opened. A non-inflamed appendix was seen. Appendectomy was performed, and the hernia was repaired by Halsted’s repair. Amyand’s hernia is a rare condition. The correct diagnosis is usually made intraoperative. Keywords: Amyand’s hernia, appendectomy, hernia repair, inguinal hernia.

Inguinal hernia is the protrusion of an organ or fascia through the wall of the cavity that contains it. It is one of the most frequent situations that surgeons must face. Typically, the content of herniary sac is omentum or small bowel, but occasionally it includes the cecal appendix, a condition called “Amyand hernia”. Diagnosis is usually established during surgical intervention. We present the case of an Amyand hernia in a 40 year-old male, who consulted by pain in the right inguinal region, lasting 10 hours. On physical examination a palpable, painful and irreducible mass was found. During surgery, the sac was observed to contain omentum and the cecal appendix, the latter with inflammatory changes. Pre-peritoneal inguinal hernia repair with application of a mesh was performed. No intra-operatory complications occurred and the outcome was satisfactory.

Background Round ligament cysts are rare lesions, often diagnosed as irreducible inguinal hernias. Most patients are in the third to fourth decade of life, but they can occur in younger patients. They are usually clinically asymptomatic or tend to produce subtle symptoms such as pain, discomfort, or a feeling of heaviness, and swelling. Cysts should not be resized with the Valsalva manoeuvre. Ultrasound is the diagnostic method of choice. The definitive diagnosis is made during surgery, and confirmed by pathological examination. Objective To present a case of round ligament cyst, initially diagnosed as an incarcerated inguinal hernia, and a review of the literature. Clinical case A 19 year-old female, who was admitted to the emergency department due to her current condition of 5 days of onset. She had an increased volume in right inguinal region that increased with physical exertion, throbbing pain, and nausea without vomiting. A right inguinal mass of approximately of 6 cm in diameter was found, which was painful on mid-superficial palpation, reaching a pre-surgical diagnosis of incarcerated right inguinal hernia with an indication of surgical intervention. Conclusion Round ligament cysts are a rare pathology, often confused with incarcerated inguinal hernias. Although ultrasound is the study of choice, the final diagnosis is usually made during surgery and confirmed by histopathology.

Indirect inguinal hernia is a common congenital abnormality in children. In female infants, herniation of the ovaries, fallopian tubes and uterus has been reported. Herniation of the ovaries is a rare congenital condition that may be complicated by strangulation, torsion, and infertility. A 6-week-old female infant presented with visible swelling in the right inguinal region. This case highlights the utility of ultrasonography as a cheap and easily available imaging technique that can be used for the characterization of the hernial contents, and guide the management, further accentuated by the use of color Doppler imaging, of this subtle but crucial entity.

We report herein a patient with an inguinoscrotal hernia containing the urinary bladder. The hernia was safely repaired using the laparoscopic transabdominal preperitoneal repair technique. A 76-year-old man was admitted to our hospital with abdominal pain, vomiting, and diarrhea. His scrotum was swollen to fist size. Abdominal CT showed herniation of the sigmoid colon and the bladder into the right inguinal region, and his abdominal pain was attributed to incarceration of the sigmoid colon; this was manually reduced. About 1 month later, we performed transabdominal preperitoneal repair. After the direct hernial orifice was identified, the bladder was noted to be sliding from the medial side of the hernia; this was reduced. Peeling on the medial side was carried out to the middle of the abdominal wall, and the myopectineal orifice was covered with mesh. The patient was discharged on postoperative day 1.

Background Small bowel adenocarcinomas are rare malignant tumors that account for less than 2% of gastrointestinal malignancies. In addition, tumor incarceration in an inguinal hernia is also rare entity. We herein report a first case of small bowel adenocarcinoma incarcerated within an inguinal hernia. Case presentation A 75-year-old man with asymptomatic anemia (hemoglobin, 8.6 g/dl) had a checkup at our hospital. Colonoscopy revealed bleeding through the ileocecal valve and an annular stricture by a tumor in the ileum. Endoscopic biopsy revealed a well-differentiated adenocarcinoma of the small bowel. Enhanced computed tomography showed a hypervascular solid tumor incarcerated within a right inguinal hernia. With a diagnosis of small bowel adenocarcinoma incarcerated within a right inguinal hernia, the patient underwent elective laparotomy with midline excision. The small bowel tumor, located at 30 cm from the terminal ileum, was incarcerated within a right inguinal hernia, and the small bowel was adherent to the hernia sac. A 24-cm segment of the distal ileum and regional lymph nodes were resected. The hernia sac was ligated, and the bottom of the hernia sac was resected. The hernia orifice was closed by tissue repair technique via a standard oblique incision in the right inguinal region. Postoperatively, the patient remains well with no evidence of tumor or hernia recurrence as of 1 year after operation. Conclusions We reported to our knowledge the first case of small bowel adenocarcinoma incarcerated within an inguinal hernia.

Highlights • Myopericytoma, a rare painless swelling in distal extremities. • A benign perivascular soft tissue tumor. • Myopericytoma often misdiagnosed as other soft tissue tumor. • Histopathology and immunohistochemistry (IHC) for diagnosis of myopericytoma., Introduction Myopericytoma is a rare mesenchymal soft tissue tumor that originates from perivascular myoid cells and mostly benign in nature. With a slight male predisposition, it occurs more commonly in the lower extremities with an insidious and painless presentation. Contrary to the usual, our patient was with a rare presentation in the inguinal region with a dull aching pain. Case presentation We herein report a case of a 64-year-old female patient with myopericytoma, the first of its kind reported in Nepal, present in the right inguinal region and surgically removed. The mass was single with dull aching pain, non-tender, globular, smooth, mobile, covered with skin and, had been slowly growing for 1 year and had started bleeding for 4 days. On complete surgical excision and subsequent biopsy, a nodule with thin-walled blood vessels and spindle-shaped cells having indistinct cell border, eosinophilic cytoplasm, and oval to spindle-shaped nucleus was observed, features consistent with those of myopericytoma. Discussion Myopericytoma can occur in different sites in the body. Its differential diagnoses in the inguinal region include inguinal hernia, lipoma, or an inguinal lymphangioma. Histopathological analysis and immunohistochemistry (IHC) staining are used for diagnosis and confirmation. Conclusion Myopericytomas are rare and have a substantial propensity to be misdiagnosed as other soft tissue tumors such as sarcomas due to significant overlap in their presentation and histological features. Complete surgical excision of mass is the curative therapy.

Highlights • Laparoscopic IPOM repair for inguinal hernia may cause chronic neuropathic pain. • Laparoscopic IPOM repair for inguinal hernia should be avoided as much as possible. • Laparoscopic selective neurectomy is an option for chronic neuropathic pain., Introduction Laparoscopic intraperitoneal onlay mesh (IPOM) repair is occasionally used for inguinal hernia repair. Here, we report a case of chronic neuropathic pain after laparoscopic IPOM repair for inguinal hernia, which was treated successfully with laparoscopic selective neurectomy. Presentation of case A 59-year-old man with bilateral inguinal hernia underwent laparoscopic repair. Transabdominal preperitoneal repair was performed on the left side, whereas IPOM repair was performed on the right side due to a peritoneal defect. At postoperative month 1, he presented with severe pain and numbness distributed from the right inguinal region to the inner thigh region. The symptoms had persisted for 1 year despite medical treatment. We diagnosed that the symptoms might be due to the entrapment of nerves in the contracted mesh, and performed a second surgery via laparoscopic approach 13 months after the first surgery. On laparoscopic exploration, the lateral side of the mesh was contracted and involved nerve branches. We ligated and cut off these nerve branches. His symptoms resolved immediately after the surgery. At postoperative month 12, he has passed without any pain, numbness, and hernia recurrence. Discussion Laparoscopic exploration would be useful to figure out chronic neuropathic pain after laparoscopic inguinal hernia repair. Conclusion Laparoscopic IPOM repair for inguinal hernia should be avoided as much as possible because it may cause chronic neuropathic pain. Laparoscopic selective neurectomy is an option for patients with chronic neuropathic pain after laparoscopic hernia repair.

To report the surgical technique, procedure outcomes, and feasibility of robot-assisted simultaneous bilateral radical inguinal with bilateral pelvic lymphadenectomy.Three consecutive patients of penile and urethral carcinoma with palpable inguinal lymphadenopathy who underwent robot-assisted simultaneous bilateral radical inguinal with bilateral pelvic lymphadenectomy in our institution from May 2013 to October 2015 were included in the study. Surgical technique is described and feasibility of the procedure is assessed.Three patients aged 58, 76, and 35 years underwent robot-assisted simultaneous bilateral radical inguinal with bilateral pelvic lymphadenectomy with a mean operative duration of 453.33 minutes (range 420-490 minutes). Average blood loss was 66.66 mL (range 50-80 mL) and mean time to removal of last drain was 44.66 days (range 28-72 days). Mean lymph node yield in left inguinal region, right inguinal region, left pelvic region, and right pelvic region was 18, 14.6, 13.3, and 16.6, respectively. The perioperative period was uneventful. No skin flap-related complications were seen. One patient suffered lymphocele postoperatively, which was managed successfully with needle aspiration. One patient developed lung metastasis in follow-up and none of them had local recurrence.Robot-assisted simultaneous bilateral radical inguinal with bilateral pelvic lymphadenectomy is feasible, safe, and may result in decreased morbidity compared to conventional open lymphadenectomy.

Introduction Inguinal hernia may contain vermiform appendix in very rare cases. This particular condition is known as Amyand’s hernia and it has an incidence of 1%. Diagnosis is very difficult preoperatively, so it is usually an incidental finding. Presentation of case We report a case of a 80 year old man with an irreducible mass in right inguinal region. During surgical procedure an Amyand’s hernia was identified and we performed hernioplasty sec Trabucco and appendectomy. Discussion According to Losanoff and Basson classification, our case was type 1 and its management is very controversial. Conclusion Surgical treatment depends on surgeon’s experience and on clinical evaluation because there are many factors that may increase morbidity and mortality.

Lymphoma involves malignancy of the lymphatic system which includes the spleen, thymus, bone marrow and lymph nodes. Diffuse large B-cell lymphoma (DLBCL) is an aggressive, rapidly-growing type of non-Hodgkin lymphoma (NHL). We present a case of an 18-year-old male who initially presented with right hindfoot pain and swelling. Initial radiographs revealed no osseous pathology that correlated with the area of pain and swelling. Magnetic resonance imaging (MRI) was obtained which revealed a large soft tissue mass surrounding the calcaneus with cortical erosion and complete marrow replacement of the calcaneus. Due to concern for malignancy, the patient underwent a fluoroscopic-guided biopsy of the calcaneus. The pathology report revealed large atypical lymphoid infiltrates that were positive for B-cell molecular markers, CD20 and PAX5, consistent with the diagnosis of B-cell lymphoma. Initial positron emission tomography (PET) scan demonstrated hypermetabolism at the right foot, right popliteal fossa and right inguinal region which was consistent with Diffuse Large B-cell lymphoma, Grade 3B, Stage I or II. The patient underwent 6 cycles of chemotherapy. The patient's pain and swelling to the hindfoot had completely resolved and the patient remains in remission.

Littre’s hernia, in which the hernia sac contains a Meckel’s diverticulum, is extremely uncommon in paediatric population. We are reporting a case of Littre hernia in a 4.5 year old male child who presented with an irreducible mass in right inguinal region. The diagnosis was made peroperatively. The patient was successfully managed by diverticulectomy and herniotomy and is doing well in follow up.J Nepal Paediatr Soc 2016;36(3):300-302

Low-grade fibromyxoid sarcoma (LGFMS) is a rare sarcoma subtype. The most common tumor locations are the deep soft tissue of extremities or trunks. We report a rare case of recurrent LGFMS in the inguinal region involving the scrotum and both testicles. A 38-year-old male patient reported a history of multiple nodular lesions in the left inguinal region accompanied by local inflammation. The patient was submitted for local resection of the lesion at our institution, with histopathological diagnosis of LGFMS. He missed his follow-up, returning with a large bulge in the left inguinal region involving the scrotum with signs of tissue necrosis and local purulent discharge. Surgical exploration was performed and the patient underwent tumor resection in the left inguinal region and the entire scrotum, with bilateral orchiectomy, with the margins enlarged to the right inguinal region and proximal surface of the penis. Local reconstruction was performed with a left fascia lata tensor muscle flap and ipsilateral thigh coverage using partial skin graft. On microscopic examination, the tumor showed spindle cells arranged in bundles, with abundant collagen and myxoid stroma with interspersed prominent vessels. The immunohistochemical study carried out showed immunoreactivity with Ki67 (

A 82-year-old Indian male patient was referred with complaints of the wound in right inguinal region for the last 15 days. He initially presented to a primary care centre with complaints of a progressive ulcer over penis for 12 months and swelling in right inguinal region for the last two months. He also revealed sloughing of penile tissue 1 month back. The discharged card mentioned that the patient received antibiotics and underwent incision/drainage of the inguinal abscess under anaesthesia. He also had difficulty in micturition. The patient denied any history …

Highlights • Obstructed direct inguinal hernia of sliding variety with bladder being one of its contents is extremely rare and no such case has been reported yet. • Though incarceration and even strangulation are extremely uncommon in direct inguinal hernia as compared to indirect inguinal hernia. A long standing direct inguinal hernia may present as acute or sub-acute intestinal obstruction especially in elderly patients. Hence old age with obstructed inguinal hernia might be of direct variety and needs to be repaired immediately. • Sliding hernias are diagnosed intra-operatively and is very difficult to identify clinically. Sliding hernias are most common in old age male, of indirect variety on left side according to most literatures. • The good operating technique and the use of modern prosthetic materials should allow us to have the same risk of early and late complications after operating on a sliding and non-sliding inguinal hernia., Introduction Direct Obstructed inguinal hernias of sliding variety with bladder as its content is extremely rare. Case Report We report the case of an 83-year-old male known case of DM, presented with irreducible and painful swelling over the right inguinal region and cough impulse on right inguinal region. On exploration of the right side, the obstructed hernia was found to be a direct type sliding hernia with sac wall forming anterior covering layer and containing congested small bowel loops (ileum) and bladder forming the medial wall of the hernia sac. After gaining viability the content was reduced, posterior wall defect was closed and Lichtenstein tension free repair was done. Conclusion Direct inguinal hernia of sliding variety getting obstructed is rare. Direct Sliding hernia on right side with ileum as content and bladder forming the wall is extremely rare.

Background A caecal appendix within an inguinal hernia, with or without appendicitis, is defined as Amyand's hernia. In 1% of inguinal hernias an appendix without inflammation can be found, however, the prevalence of appendicitis in a hernia sac is only 0.08–0.13%. Clinical case Male of 43 years old began two days before admission with pain in the right inguinal region. He was scheduled for surgery due to a complication of a right inguinal hernia. The surgical findings were Amyand's hernia, necrotic spermatic cord, and perforated appendix. Surgical repair was performed with a favourable outcome, and he was discharged on the fourth postoperative day. Discussion Most of Amyand's hernia exhibit characteristics of incarcerated or strangulated inguinal hernia. Even acute appendicitis or perforated appendix within the hernia sac does not reflect specific symptoms or signs, therefore, a preoperative clinical diagnosis of Amyand's hernia is difficult to achieve. In our case, the patient had perforated appendicitis, developing necrosis of the spermatic cord. Orchiectomy, appendectomy, and inguinal hernia repair was performed without placing mesh. Due to the controversy on the use of mesh in contaminated abdominal wall defects, it was not indicated here, due to the high risk of wound infection and appendicular fistula. Conclusion An extremely rare condition is presented, with a surgical choice that led to a favourable outcome.

Introduction Spigelian hernia (SH) is a rare ventral hernia occurring near the lateral border of the rectus muscle. The treatment remains controversial and depends on institutional expertise. Although laparoscopic surgery is a good adaptation for the repair of ventral hernias, only a few cases have been reported in the literature. Here, we report a case of totally extra-peritoneal (TEP) repair for bilateral SHs. Presentation of case A 74-year-old Japanese man presented with asymptomatic bulges in the right lower abdominal quadrant. On physical examination, the bulges were located to the right of the lateral border of the abdominal rectus muscle and the right inguinal region in an upright position. We diagnosed right SH and coincident homonymous ipsilateral inguinal hernia (IH) by abdominal computed tomography and planned a curative operation by laparoscopy. By first laparoscopic exploration, we found an asymptomatic SH to the left of the lateral border of the abdominal rectus muscle and performed TEP repair for all hernias. The second laparoscopic exploration after fixing the mesh in place revealed that the orifice of the right SH was scarred and stiffened by repeated prolapse. We finally eliminated the sac by ligation because of a fear causing of reduction en masse of the SH. Discussion and conclusion The use of laparoscopy simplified the diagnosis and facilitates the subsequent repair of the hernia. TEP approach is the ideal treatment for the simultaneous laparoscopic repair of SH and IH.

Atopic dermatitis is a common allergic skin disease in dogs. Monitoring the progress of treatment and the assessment of the severity of disease symptoms are crucial elements of the treatment procedure. One of the common means of assessing the severity of the clinical signs of the disease is the CADESI 03. Research studies have pointed to a possibility of assessing the severity of skin lesions by means of measuring biophysical skin parameters such as TEWL, skin hydration and erythema intensity. The aim of the study was the assessment of changes in TEWL and CADESI values measured in ten different body regions during non-specific anti-pruritus treatment. The examination was performed on ten dogs with atopic dermatitis (age from 2.5 years to 7 years, mean age 3.8 years). The measurements were performed in the following body regions: the lumbar region, the right axillary fossa, the right inguinal region, the ventral abdominal region, the right lateral thorax region, the internal surface of the auricle, interdigital region of the right forelimb, cheek, bridge of nose and the lateral site of antebrachum. A statistically significant decrease in CADESI values was reported starting from the second week of treatment. In the case of the mean TEWL values, a fall was observed after one week of treatment in the ventral abdominal region and the interdigital region, after two weeks of treatment in the axillary fossa and the inguinal region, and after three weeks in the cheek and the lateral thorax region. There was no statistically significant decrease in TEWL values in the course of treatment in four other regions.

Highlights • A de Garengeot hernia is a femoral hernia containing the appendix. • Diagnosis of a de Garengeot hernia is difficult and often made intra-operatively. • Incarceration or strangulation tends to be the clinical presentation of a de Garengeot hernia. • It is important to have a high clinical suspicion for a de Garengeot hernia in patients with incarcerated or strangulated right femoral hernias., Introduction A de Garengeot hernia, a femoral hernia containing the appendix, is a difficult diagnosis often made intra-operatively when the hernia sac is opened. It is a rare finding, and complications are more frequent with a de Garengeot hernia. Presentation of case A 92 year-old female presented to the emergency department (ED) complaining of abdominal pain. A computed tomographic (CT) scan of the abdomen and pelvis demonstrated a hernia anterior to the inguinal ligament without strangulation. Two weeks later the patient returned to the ED with worsening abdominal pain in the right lower quadrant. Repeat CT scan demonstrated a 7 × 4 cm complex fluid collection in the right inguinal region, and the patient was taken to the operating room for exploration. The hernia sac was entered and found to contain the appendix with evidence of distal perforation. The appendix was taken out, and the hernia defect was repaired. The patient tolerated the procedure well. Discussion Femoral hernias have a high risk of incarceration due to the tightness of the femoral canal (Talini et al. 2015 [4]). Due to anatomic location of the appendix, de Garengeot hernias are most often seen on the right. Incarceration of the appendix is a clear etiology for appendicitis secondary to ischemia. Conclusion Full preoperative workup for a femoral hernia often fails to diagnose the presence of the appendix within the hernia. It is important to have a high clinical suspicion for a de Garengeot’s hernia in patients with incarcerated or strangulated right femoral hernias.

Clinical-Medical Image: We report a case of a young patient brought to emergency department by police ambulance for management of gunshot injury after getting shot by a policeman. First clinical examination found a conscient and hemodynamically stable patient and a huge ecchymosis of external genitalia with deviation and swelling of penile with a puncture wound on the left side of the base of the penis probably corresponding to the exit orifice of the bullet. Ultrasonography with Doppler was found a bilateral rupture of cavernous bodies as well as a left testicular hematoma without rupture of the tunica albuginea and an extensive hematoma of the right inguinal region. CT-scan revealed a complex sub-trochanteric fracture of the femur with a wound at the superficial femoral artery (Figure 1). Surgical repair was performed with initially a venous bypass for the femoral artery and suture of the cavernous bodies. No urethral lesion was found and he was operated one month later for his fractured femur (Figure 2). External genital gunshot injuries are rare both in war field and in civil practice. Its occurrence in civilian practice makes it possible to establish good diagnostic and therapeutic strategies given the availability of complementary exploration means. Ballistic traumas are the result of penetration into the body of a projectile. No physical theory can predict with certainty the behavior of a projectile in the human body. Damages are greater when projectiles collide with dense structures such as bones resulting in a high energy transfer. CT-scan help to assess with great sensitivity the associated lesions in this case it allowed diagnosing other serious and life-threatening associated injuries.

Background Spinal extradural arachnoid cysts (SEACs) are relatively rare and usually asymptomatic. They preferentially are situated in the thoracic extradural space and almost always dorsal. SEACs may present with back pain and/or cord compression symptoms. Needle aspiration, needle fenestration, or open surgical resection/fenestration have been reported as treatment modalities. Case Description We present a 35-year-old woman who complained of radiating pain from the right lower thoracic region of her back toward the right inguinal region, which was aggravated upon defecation and straining. Magnetic resonance imaging (MRI) revealed an extradural cyst located laterally at T11–T12 level on the right, with a nerve root herniation. During a T11–T12 hemilaminectomy, on resection of the cyst wall, a nerve root was noted to be herniating into the cyst cavity through a dural defect. The nerve root was released and repositioned intradurally, followed by direct suture of the dural tear. Histologic findings of the cyst wall confirmed an arachnoid cyst. Postoperative course was uneventful without complications. Postoperative MRI confirmed a complete resection of the cyst. Five years after surgery, the patient is asymptomatic with complete recovery. Conclusions Thoracic SEACs can present with radiating pain due to a transdural herniation of a thoracic nerve root into the cyst, potentially due to a mechanism of intermittent pressure gradients between the intradural and extradural spaces. MRI can prove beneficial in visualizing the nerve prolapsing into the cyst. Open resection of the cyst wall, reduction of the nerve root herniation, and subsequent direct closure of the dural tear led to complete recovery.

Background The leading cause of surgical pneumoperitoneum is hollow viscus perforation, which accounts for approximately 90% of cases. A nonsurgical etiology may account for up to about 10% of the causes of pneumoperitoneum. However, a pneumoperitoneum often poses significant management dilemmas for surgeons, especially when signs of peritonitis are absent or when the cause is unknown prior to laparotomy. We present the first case of pneumoperitoneum due to inguinal laceration without viscus perforation after a traffic accident. Case Report A 17-year-old male patient was admitted to the emergency department with a deep laceration of 7∼8 cm with bleeding in the right inguinal region after a collision with a passenger car while riding a bicycle. The abdominal examination revealed diffuse abdominal tenderness on deep palpation without peritoneal signs. A chest radiograph showed no free gas below the diaphragm. On computed tomography angiography of the aorta, subcutaneous emphysema in the right inguinal and femoral areas and free air in the peritoneal cavity were observed. There was no bowel perforation in an exploratory laparotomy, but the right femoral sheath ruptured, and exposure of the femoral vessels into the peritoneal cavity was observed. Why Should an Emergency Physician Be Aware of This? A pneumoperitoneum can be caused by femoral sheath rupture without hollow viscus perforation in patients with a penetrating groin injury. Therefore, emergency physicians should not pursue solely abdominal/pelvic sources of a pneumoperitoneum in patients with a penetrating groin injury.

Background Amyand`s hernia is rarely noted in children, and appendicitis caused by a foreign body in Amyand`s hernia is even rarer. Case A 2-year-old girl presented with recurrent conglomerate lymph node enlargements and an abscess in the right groin existing for one year despite medical treatment. Direct radiography revealed a foreign body in the right inguinal region. Computed tomography showed a foreign body and soft tissue inflammation in the inguinal canal. Laparotomy was performed, and Amyand`s hernia was diagnosed. A foreign body was found in the lumen of the appendix vermiformis causing perforated appendicitis. This case is presented because of its rarity and unusual clinical presentation. Conclusion Amyand`s hernia should be considered in paediatric cases with the history of recurrent inguinal abscesses.

A 14-year-old boy presented with a painful swelling topped by a bruise overlying the skin of the right inguinal region without peritonitis. This was the area of impact of bicycle handlebar while riding 6 days ago. On contrast-enhanced CT scan, we found a traumatic abdominal wall hernia (handlebar hernia) near the right deep ring without any solid organ, bowel or urinary bladder injury. Inguinal exploration revealed a defect in transversus abdominis and internal oblique muscle which was repaired and meshplasty was done.Delayed presentation and ignorance towards ‘handlebar sign’ is associated with visceral injury (haematoma/perforation) will incur the risk of rising morbidity and mortality. With CT scan we can assess the abdominal cavity to rule out associated visceral or vascular injury. Surgical repair for restoring disrupted anatomy with or without meshplasty is the preferred approach.

Introducción: Hernia de Amyand es un hallazgo donde el apéndice con o sin inflamación se encuentra en el saco de una hernia inguinal. La prevalencia es muy baja se describe entre el 0.4% y 0.13% de todas las hernias inguinales, mientras que en los niños podría alcanzar el 1%. Objetivo: Describir un caso clínico de de hernia de Amyand. Material y métodos: Se realizó un estudio descriptivo, retrospectivo, presentación de caso clínico sobre de hernia de Amyand. Resultados: Se describe el caso de un paciente masculino de 54 años de edad con antecedentes de masa en región inguinal derecha, que ha ido aumentando de tamaño, desde aproximadamente 1 año de evolución, acompañado de dificultad a la deambulación, al acudir a consulta externa de cirugía en la exploración física en región inguinal derecha se evidenció masa de más o menos 3 centímetros de diámetro, reductible, en la paraclínica rangos normales, fue llevado al quirófano para reparación laparoscópica con diagnóstico de hernia inguinal derecha, donde se evidenció hernia inguinal derecha con saco herniario con contenido de apéndice cecal, condición que se conoce con el nombre de hernia de Amyand. Conclusiones: Al evidenciar un paciente con hernia de Amyand que no es un caso común, cuando se asocia a apendicitis la prioridad es la realización de la apendicetomía y en segundo lugar la reparación del defecto herniario de la pared, con malla protésica, aunque sigue siendo controversial ante la posibilidad de infección local por apendicitis aguda, a pesar de ello se implementó esta opción terapéutica con éxito

A vascular closure device (VCD) can be useful, but an infected pseudoaneurysm caused by a VCD can be serious and fatal. A 79-year-old man underwent EVT for right iliac artery using a VCD. An abscess formed in the right inguinal region 1 week later and CT revealed a right femoral artery