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Management of obstetrical and gynecologic patients with hernias poses challenges to providers. Risks for hernia development include well-described factors that impair surgical wound healing and increase abdominal pressure. Among the diverse populations cared for by obstetricians and gynecologists, pregnant patients and those with gynecologic malignancies are at the highest risk for hernia formation. This article provides an overview of the existing literature, with a focus on patients cared for by obstetrician–gynecologists and commonly encountered preoperative and intraoperative scenarios. We highlight scenarios when a hernia repair is not commonly performed, including those of patients undergoing nonelective surgeries with known or suspected gynecologic cancers. Finally, we offer multidisciplinary recommendations on the timing of elective hernia repair with obstetrical and gynecologic procedures, with attention to the primary surgical procedure, the type of preexisting hernia, and patient characteristics. [ABSTRACT FROM AUTHOR]

Uretero-inguinal hernia (UIH) is a rare condition in children. We present our experience with an unexpected UIH in a male infant with associated anomalies and a literature review of pediatric cases. A full-term male newborn was referred to our hospital for microcolon and right hydroureteronephrosis. Voiding cystourethrography showed grade-IV right vesicoureteral reflux and a dilated, convoluted, ureter protruding in the right inguinal canal, suggesting a right UIH, which was uneventfully repaired at 2 months of life. UIH is a rare type of inguinal hernia in children that pediatric urologists and surgeons should be aware of. In experienced hands, and when preoperatively suspected, surgical management is safe and effective. [ABSTRACT FROM AUTHOR]

Trocar site hernia is a rare but potentially serious complication of laparoscopic surgery that may lead to bowel incarceration and strangulation. Prompt diagnosis by emergency physicians facilitates timely intervention that prevents bowel necrosis. We report a case of trocar site hernia presenting to the emergency department (ED) with abdominal pain that was correctly diagnosed and promptly managed. A 25-year-old woman, gravida 2, abortion 2, underwent outpatient surgery and laparoscopic removal of a ruptured right-sided tubal pregnancy without any intraoperative difficulties. However, 48 h later, she presented to the ED complaining of acute abdominal pain and nausea. Computed tomography revealed a loop of small bowel herniating through a 12-mm right lower quadrant trocar site defect in the fascia. She was taken back to the operating room, where the computed tomography findings were confirmed and the entrapped bowel was successfully reduced and the fascial defect repaired. The patient was discharged home feeling much improved. Trocar site hernia is a rare but potentially dangerous complication that can present with acute symptoms or be asymptomatic if late in onset. Intestinal necrosis begins as soon as 6 h after constriction of blood flow to entrapped bowel, so timely intervention is critically important. Therefore, trocar site hernias should be considered in patients presenting with abdominal complaints after laparoscopic surgery and included in the differential diagnosis of bowel obstruction. [ABSTRACT FROM AUTHOR]

• A notable proportion of people (35 out of 106, 33%) with a Workers' Compensation claim for hernia have an incidental (asymptomatic) hernia elsewhere. • People who have a second, incidental hernia, are either less likely to be offered or less likely to choose surgery. • Our data support that hernia might be incidental to abdominal symptoms (e.g. muscle strain) but is unlikely to be caused by strenuous physical activity. • Population-based studies of the prevalence of incidental hernia by occupation and longitudinal studies of people starting heavy labor occupations can help determine if there is an association between heavy work and pathology of abdominal hernia. There is a gap in evidence that demonstrates an increased risk of hernia formation in laborers. A notable incidence of a second asymptomatic hernia among people making a workers' compensation claim for a hernia would suggest that the pathology is not acute and probably not related to work, or the performance of a single strenuous event. We performed a retrospective database study of a consecutive sample of 106 adults who claimed a work-related abdominal hernia between September 2016 and December 2018 and had a Computed Tomography (CT) scan as part of a diagnostic workup. Hernias were classified as incidental if patients had a contralateral inguinal hernia with unilateral groin symptoms, or if patients had a ventral hernia with only groin symptoms or vice versa. Thirty-three percent of patients had an incidental hernia. No patient factors were associated with having an incidental hernia. Higher BMI and having a concurrent incidental hernia were associated with lower odds of surgical treatment under the injury claim. Abdominal symptoms after a work event might lead to a diagnosis of hernia, and there is a notable likelihood that the hernia is incidental and unrelated to work. New symptoms at or near the site of an abdominal hernia may or may not be from the hernia, and very often are more consistent with an abdominal muscle strain. The clinical or imaging finding of an abdominal wall defect or the presence of a hernia may be incidental, unrelated to the physical activity. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) is an optimal imaging modality for the risk stratification of patients presenting to the emergency department (ED) with inguinal and femoral hernias, allowing for better evaluation of clinical presentations and guiding appropriate treatment. The lack of ultrasound classification for inguinal and femoral hernias has led to inconsistent use and often underuse of POCUS in this patient population. Several groin hernia classifications are available, but most are complex and often targeted toward surgical management.Objectives: The objective of this study is to review the use of POCUS in the diagnosis of inguinal and femoral hernias, providing a synopsis of critical ultrasound findings in determining signs of incarceration, strangulation, and small bowel obstruction, and suggesting a simple and educative sonographic classification for inguinal or femoral hernias.Discussion: POCUS can reliably confirm the presence of groin hernias and can uniquely identify specific ultrasound findings predictive of complications, such as aperistaltic nonreducible bowel loops, free fluid in the hernia sac, and lack of color doppler in the entrapped mesentery and bowel walls. POCUS can also aid in determining the presence of small bowel obstruction by detecting dilated loops of bowel >25 mm adjacent and proximal to the hernia site.Conclusions: In the ED, POCUS can confirm the presence of a hernia sac and identify and predict surgical emergencies, such as bowel incarceration or strangulation, which are the most important elements in the management of patients presenting with possible inguinal or femoral hernias. [ABSTRACT FROM AUTHOR]

Morgagni hernias are not common yet should be considered in the patient presenting to the Emergency Department with severe epigastric pain, pulmonary symptoms, and/or obstruction where more common conditions have been ruled out. After 6 weeks, the pain returned and a computed tomography (CT) scan of the abdomen revealed a Morgagni hernia with incarcerated, but not obstructed, transverse colon (Fig. 2 CT scan; incarcerated Morgagni hernia containing transverse colon. [Extracted from the article]

Groin hernia repair is one of the most common surgeries performed in the United States, with more than 700,000 performed every year. These repairs are commonly performed in an elective setting to alleviate symptoms and prevent obstruction and/or strangulation. Prior studies have demonstrated that watchful waiting is a reasonable option compared with surgery, because of the low risk of life-threatening complications from groin hernias. However, other studies have demonstrated that there is increased risk of mortality after surgery in older persons (age ≥65 years). Therefore, the question is if and when older patients should pursue groin hernia repair. In this article, we provide an evidence-based overview on the management and treatment of inguinal hernia repair in older persons. Focusing on which patients should be repaired, the optimal timing of surgery, what is the best anesthesia, how the repair should be performed, and the importance of understanding frailty should help surgeons and primary care physicians determine the best management of inguinal hernias in older adults. [ABSTRACT FROM AUTHOR]

The evaluation of the re-admission rate within 30 days of inguinal hernia repair represents a patient management quality indicator. The goal of our study was to evaluate the re-admission rate at 30 days after inguinal hernia repair and identify the risk factors for re-admission. Based on a prospective national registry, patient data were collected during two years. The number of and reasons for re-admissions were compiled. A total of 5126 patients, mean age 61 years, underwent inguinal hernia repair. Ambulatory surgery was performed in 4013 (78%) patients. Failed ambulatory surgery was recorded for 100 (2%) patients. Thirty-three (0.64%) patients were re-admitted within 30 days following surgery for 34 various reasons. The re-admission rate after ambulatory surgery was 0.5%. Half of patients re-admitted presented with a severe complication that required re-intervention. In multivariable analysis, emergency hernia repair (OR 4.899 [1.309-18.327]; P = 0.01) and prolonged duration of operation (OR 1.023 [1.009-1.037]; P = 0.001) were identified as independent risk factors for re-admission within 30 days after surgery. Within this prospective national cohort, the overall re-admission rate after inguinal hernia repair was 0.64%, slightly less among the patients undergoing ambulatory surgery. Half of re-admitted patients required surgical re-operation. Emergency hernia repair and prolonged duration of operation were risk factors for re-admission. [ABSTRACT FROM AUTHOR]

Background: The use of mesh in hernia repair has faced intense scrutiny, leading patients to become fearful of its use, despite its benefits in reducing hernia recurrence. We report a single institutional experience in performing hernia repair with mesh in terms of hernia-specific outcomes, mesh-related complications, and patient-reported quality of life.Study Design: Patients who underwent abdominal wall hernia repair with mesh at a single institution were identified from a prospectively maintained quality database. Demographic, perioperative, and postoperative outcomes data were analyzed. Surgical Outcomes Measurements System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1, 2, and 5 years.Results: Between 2010 and 2020, a total of 6,387 patients underwent abdominal hernia repair with mesh. Inguinal hernia repairs made up the majority (65%) of the operations. Rates of mesh infection varied by hernia type, with lower rates after umbilical (0.0%) and inguinal (0.4%) repair, and highest after incisional repair (1.3%). Similarly, mesh explantation rates were low after umbilical and inguinal repair (0.0% and 0.4%, respectively) and highest after incisional repair (3.0%). Scores on all SOMS domains were significantly improved from baseline (all p < 0.05). On CCS, 2.9%, 3.3%, and 4.4% of patients reported severe or disabling symptoms postoperatively at 1, 2, and 5 years, respectively.Conclusions: Rates of mesh-related complications vary by hernia type. A majority of patients report excellent long-term quality of life, although a relatively large percentage of patients experience severe or disabling symptoms at long-term follow-up. [ABSTRACT FROM AUTHOR]

The number of renal transplants has been increasing in recent years. Recent literature data show that abdominal operations performed on patients who undergo renal transplant have higher morbidity and mortality. A 49-year-old man who had received a renal transplant from a living donor 19 years ago underwent Lichtenstein tension-free hernia repair. Anuria was observed after the operation. Renal ultrasound demonstrated massive hydronephrosis and an elevated serum creatinine level (4.6 mg/dL). It was thought that the ureter may have been obstructed because of the operation, and, with the patient under local anesthesia, all sutures and polypropylene mesh were removed. Urine output was still not present, so a percutaneous nephrostomy catheter was inserted to normalize renal function. The patient underwent reoperation under general anesthesia 45 hours after the first operation. It was observed that the ureter was ligated during high ligation. The ureter was released, and no additional intervention was performed. The patient was discharged 6 days later with a return to basal creatinine level and a percutaneous nephrostomy catheter. The patient was hospitalized twice for severe urinary tract infection and urosepsis within 3 months and received appropriate treatment. The patient has had an uneventful postoperative course for 18 months. Inguinal hernia repair is seen as a safe surgical procedure, but the risk of emerging urological complications is higher in patients with renal transplant. Imaging before surgery to identify the anatomy of the kidney and ureter may be useful. Delicate dissection of the extraperitoneal area during the operation will reduce surgical complications. [ABSTRACT FROM AUTHOR]

3 A Schematic view of the supra-vesical hernia of our patient: the hernial sac runs anterolateral to the wall of the bladder. It is frequently discovered intraoperatively.[2] In our case, the abdominal CT scan showed an incarcerated intestinal loop in a pre-vesical hernial sac (in the Retzius) that suggested mainly a supra-vesical hernia. This is called the external supra-bladder hernia.[1] However, in few cases, the hernial sac develops in the peri-vesical space and looks like a pre-vesical, para-vesical, lateral, or intra-vesical deep diverticulum. [Extracted from the article]

Giant inguinoscrotal hernias are rarely encountered in clinical settings, and their repair is technically challenging. The aim of this study is to evaluate the efficacy of transinguinal preperitoneal repair (TIPP) of giant inguinoscrotal hernias using Kugel mesh. A retrospective analysis was conducted on 9 patients with 11 giant inguinoscrotal hernias who underwent TIPP repair using Kugel mesh between December 2008 and January 2019. Demographics and perioperative and postoperative data were collected, and the operative experience was summarized. The patients underwent a successful repair procedure with simultaneous omentectomy but without resection of the other abdominal organs. The median operation time was 120 min, the median intraoperative blood loss was 75 mL and the median defect area was 72 cm2. The median duration for diet restoration was 4 days, and the median postoperative hospital stay was 6 days. The drainage tube placed in the preperitoneal space was removed after a median duration of 5 days, and the drainage tube placed in the distal hernia sac was removed after a median duration of 6 days. Three patients suffered from a postoperative increase in intra-abdominal pressure, while one patient deteriorated into abdominal compartment syndrome accompanied by respiratory dysfunction. No haematomas, seromas, incisional or mesh infections, recurrence or chronic pain occurred during the follow-up period. TIPP repair using Kugel mesh is a feasible and effective method for giant inguinoscrotal hernias. [ABSTRACT FROM AUTHOR]

Groin hernia repair constitutes a very common procedure in general surgery. Minimal invasive closure of groin hernia has evolved to become the standard means of closure. However, there seems to be a gender-associated discrimination with regard to endoscopic groin hernia repair. We investigated the rate of endoscopic closure in female patients undergoing groin hernia closure. A retrospective analysis of the data of patients undergoing elective groin hernia repair within a four-year period from 2013 to 2016 was performed. The rate of endoscopic hernia repair was calculated for both genders. Eight hundred and forty-six patients including 94 females and 752 males were included for analysis. The female group was significantly older compared to the male group (68.0 vs. 61.0 yrs, P = 0.02). The rate of endoscopic groin hernia repair was significantly lower in the female group compared to in the male cohort (30% vs. 60%, P = 0.001). The overall duration of surgery was 74.0 min in the female cohort and 93.0 min in the male group, P = 0.001. However, there was no statistically significant difference amongst both groups with regard to the duration of surgery for endoscopic repair: 78.0 min in the female group and 89.0 min in the male group, P = 0.67. Findings from this retrospective collective suggests that, there might be some degree of sex discrimination with regard to endoscopic groin hernia repair in favor of the male population. [ABSTRACT FROM AUTHOR]

A 68-year-old male patient received a living donor kidney transplantation 8 years earlier for end-stage kidney disease secondary to IgA nephropathy. His post-transplantation follow-up had been routinely performed with laboratory examinations, ultrasound, and computed tomography (CT). His kidney graft function had been excellent and stable, as shown by a baseline serum creatinine level of 1.0 mg/dL. At referral, regular follow-up ultrasound and CT showed allograft hydroureteronephrosis. He did not have any complaints, but his physical examination revealed right inguinal bulging that was 3.5 × 3.5 cm. Abdominal enhanced CT revealed transplant allograft hydroureteronephrosis due to ipsilateral herniation of ureteroneocystostomy into the right inguinal canal. His serum creatinine level was slightly elevated (1.1 mg/dL). Then, he underwent an open right inguinal hernia repair. Paraperitoneal allograft hydroureteronephrosis and bladder herniation was confirmed at surgery, and hernioplasty with polypropylene mesh reinforcement was successfully performed. The postoperative course was uneventful. He was discharged on the seventh day after surgery. Six weeks after surgery, CT revealed disappearance of allograft hydroureteronephrosis and no sign of inguinal hernia recurrence with the serum creatinine stable at 1.0 mg/dL. Transplant ureteral obstruction due to inguinal hernia is a rare complication after kidney transplantation. However, transplant ureter or bladder herniation should be considered in the differential diagnosis of graft hydroureteronephrosis for preventing allograft loss. • Inguinal herniation of the transplant ureter is the possible cause of hydrouteronephrosis after kidney transplantation. • Transplant ureter or bladder herniation should be considered in the differential diagnosis of graft hydroureteronephrosis. • Timely management is necessary for preventing kidney graft loss. [ABSTRACT FROM AUTHOR]

Objective: To present our long-term experience of bladder plate herniation technique in patients with bladder exstrophy epispadias complex (BEEC) and inadequate bladder plate.Methods: Ten BEEC patients with inadequate bladder plates were referred. The bladder underlying fascia was opened and the exstrophic bladder was fixed above the peritoneal cavity to herniate the peritoneal contents beneath the bladder plate so that the abdominal pressure would be directly transferred to the posterior bladder wall; causing gradual bladder expansion and auto-augmentation. In 5 patients, the inguinal hernia was fixed to increase the pressure transferred to the exstrophic bladder. The bladder capacity was measured while the patient was crying and when the bladder was enlarged. Cystometry and voiding cystourethrogram were performed before the application of this technique and during the next 6 to 8 months, to determine the bladder capacity for further primary bladder closure.Results: The bladder was enlarged during straining/crying without any complications. The average bladder capacity was increased about 2.5 to 3 times after 8 months of follow-up so that it was suitable for undergoing primary closure. None of the children needed bladder augmentation following the single-stage total BEEC reconstruction.Conclusion: This technique seems to be safe, effective, and feasible in patients with small-sized bladder and may be performed before the primary closure to increase the success rate. This technique may be effective in increasing the bladder capacity for staged bladder closure and bladder neck reconstruction without further need for bladder augmentation. [ABSTRACT FROM AUTHOR]

Management of incarcerated hernias is a common issue facing general surgeons across the USA. When hernias are not able to be reduced, surgeons must make decisions in a short time frame with limited options for patient optimization. In this article, we review assessment and management options for incarcerated ventral and inguinal hernias. [ABSTRACT FROM AUTHOR]

Inguinal hernia is the most common pediatric surgical condition, and emergency surgery is required when the hernia is incarcerated. Occasionally, the inguinal hernia contains the appendix, which is referred to as Amyand hernia (AH). We describe a laparoscopic percutaneous extraperitoneal closure (LPEC) id an incarcerated AH. A 1-year-old boy presented with a bulge in the right inguinal region consistent with an inguinal hernia. Manual reduction was not possible, so we decided to proceed with a laparoscopic emergent repair. Intra-abdominal observation revealed that the cecum, the end of the ileum, and the appendix were incarcerated through the right deep internal inguinal ring, leading to the diagnosis of an AH. The hernia contents were reduced by external manual compression during surgery, and the patent processus vaginalis was closed with non-absorbable suture using the LPEC technique. The appendix was not inflammed. At 4 years of postoperative follow-up, neither recurrence of the hernia nor acute appendicitis have been observed. LPEC is a feasible treatment option for incarcerated AH. It allows a proper high ligation of the hernia sac, and allows evaluating the condition of the incarcerated bowel after its reduction. • Presence of the appendix in an inguinal hernial sac is termed Amyand's hernia. • Amyand's hernia is very rare in children. • We achieved good results with laparoscopic percutaneous extraperitoneal closure for pediatric Amyand's hernia. • This procedure is very useful for irreducible Amyand's hernia without appendicitis. [ABSTRACT FROM AUTHOR]

Canal of Nuck hydrocele is a rare condition in females. Due to mild symptoms, it may be neglected, leading to complications, including infection and bleeding. The rarity of this condition, coupled with its potential for adverse outcomes, necessitates a high index of suspicion among treating surgeons to diagnose and promptly manage the case. We present five cases of the canal of Nuck hydrocele. We prospectively studied five cases of the canal of Nuck hydrocele admitted to our surgical department over two years. Three patients presented with painless, non-tender inguinal swelling, while two had tenderness. Three patients had a right-sided canal of Nuck hydrocele, one had a left-sided, and one had bilateral hydroceles. One patient had an associated indirect inguinal hernia. All patients were treated by carefully dissecting the hydrocele from the round ligament, followed by ligation of the canal of Nuck near the deep inguinal ring. The associated hernia was treated using herniotomy. All patients had an uneventful postoperative course with no recorded postoperative wound infection or recurrence. The hydrocele of the Canal of Nuck develops from the failure of complete obliteration of the processus vaginalis in female patients. Most cases are asymptomatic and are usually found incidentally as painless swelling in the inguinolabial region. Surgery is the treatment of choice, as there is an increased incidence of associated complications such as infection and bleeding, and it also helps to confirm the diagnosis. The surgical procedure involves resection of the hydrocele, ligation of the neck of the processus vaginalis, and repair of any associated hernia, if present. The canal of Nuck hydrocele is often overlooked in female pediatric patients with inguinolabial masses. Surgeons must maintain a high index of suspicion and perform prompt ultrasound examinations for an accurate diagnosis. Early surgical intervention is of utmost importance for preventing morbidity. • We present five cases of hydrocele of Nuck. • Hydrocele of canal of Nuck presents with unilateral or rarely bilateral painless inguinal swelling. • Hydrocele of the canal of Nuck is a rare cause of inguinal swelling often leading to misdiagnosis and improper treatment. • Surgical excision with high pouch ligation should be done for optimal outcomes. [ABSTRACT FROM AUTHOR]

Large and complicated hernias are doubly challenging; not only must the hernia be treated according to a degree of severity, but it also necessary to prevent compartment syndrome during reintegration of the viscera. Possible complications range from intestinal necrosis to perforation of the hollow organs. We are presenting the rare case of a duodenal perforation in a man with large strangulated hernia. [ABSTRACT FROM AUTHOR]

To present factual data on the medico-legal aspects of medicolegal claims after abdominal wall surgery in France. Analysis of the complaints following parietal surgery that were addressed to a company that specializes in medical malpractice insurance between 2010 and 2016. Of 209 files, 180 were analyzable; these included 75 women and 105 men with a mean age of 51 years and a mean BMI of 29.8. Cases were mainly heard by the Conciliation and Compensation Commission (CCI) (82 patients) and the High Court (79 patients). The surgical procedures concerned were groin hernias (85 patients) or anterior abdominal wall hernias (95 patients). Conventional open surgery was performed in 123 patients and laparoscopic surgery in 57 patients. The incidents motivating patient complaints after groin hernia surgery were chronic pain (27 patients), infection (24 patients), testicular damage (10 patients). Seven patients died as a result of this surgery (including one fetus). Claims after ventral hernia repair were motivated by infections (46 patients) and post-operative peritonitis or bowel obstruction (12 patients). Nine patients died following these ventral hernia repairs. Surgical error was identified in 59 of the 168 cases analyzed (35.1%); 44% of recognized faults were surgical site infections, 27% linked to delay in re-operation, and 20% were related to the operating room environment. Hernia surgery, although an everyday event for many practitioners, requires the same rigor as all other visceral surgery. [ABSTRACT FROM AUTHOR]

This study investigated the clinical application value of the automated breast volume scanner (ABVS) in patients with abdominal external hernias. A total of 121 abdominal external hernias from 103 inpatients were examined with both conventional handheld ultrasound (HHUS) and the ABVS before surgery. The rate of detection of abdominal external hernias and the diagnostic accuracy of classifying inguinal hernias using the two modalities were compared between junior and senior sonographers. Additionally, the sonographic appearance of abdominal external hernias with the ABVS system was evaluated. The results revealed that junior sonographers had a higher detection rate with the ABVS (92.6%) than with HHUS (83.5%). For the classification of inguinal hernias, the accuracy of junior sonographers using the ABVS was 89.2%, which was higher than that for the HHUS system (77.6%), but there was no significant difference between HHUS (92.7%) and the ABVS (93.1%) for senior sonographers. Measurement of the hernia orifice size with the ABVS was accurate. In addition, the ABVS could provide coronal images and visually revealed the contents of the hernia, the shape of the hernia orifice and the pathway of herniation, as well as the relationship with adjacent tissues. Therefore, the clinical application value of the ABVS for abdominal external hernias is excellent. [ABSTRACT FROM AUTHOR]

Highlights • Medial TAP block is a new and novel technique of regional analgesia. • In medial TAP block, local anesthetic is administered a little more medially, just close to the origin of the transverse abdominis muscle. • It is a simple and easily performed procedure. • Can serve as a useful alternative to ilioinguinal-iliohypogastric nerve block for providing postoperative pain relief in inguinal hernia repair patients. Abstract Purpose Analgesic efficacy of ultrasound-guided transverse abdominis plane block, administered a little more medially, just close to the origin of the transverse abdominis muscle has not yet been investigated in patients undergoing unilateral inguinal hernia repair. We hypothesised that medial transverse abdominis plane block would provide comparable postoperative analgesia to ilioinguinal-iliohypogastric nerve block in inguinal hernia repair patients. Methods This prospective, randomised trial was conducted in 50 ASA I and II male patients ≥ 18 years of age. Patients were randomised into two groups to receive either pre-incisional ipsilateral ultrasound-guided ilioinguinal-iliohypogastric nerve block or medial transverse abdominis plane block, with 0.3 ml/kg of 0.25% bupivacaine. Our primary objective was postoperative 24-hour analgesic consumption and secondary outcomes included pain scores, time to first request for rescue analgesic and side effects, if any, in the postoperative period. Results There was no significant difference in the total postoperative analgesic consumption [group I: 66.04 mg; group II: 68.33 mg (P value 0.908)]. Time to first request for rescue analgesic was delayed, though statistically non-significant (P value 0.326), following medial transverse abdominis plane block, with excellent pain relief seen in 58.3% patients as opposed to 45.8% patients in ilioinguinal-iliohypogastric nerve block group. Conclusion Medial transverse abdominis plane block being a novel, simple and easily performed procedure can serve as an useful alternative to ilioinguinal-iliohypogastric nerve block for providing postoperative pain relief in inguinal hernia repair patients. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernias are common entities. Occult inguinal hernias are difficult to diagnose on examination and can cause groin and pelvic pain. Imaging is heavily relied on to help diagnose these hernias; as such, correct interpretation of imaging studies can prevent delay in treatment for a patient with pain. We evaluated the accuracy and reliability of radiologic reports for detection of occult inguinal hernias in patients with groin and pelvic pain.Study Design: All CT and MRI studies ordered for groin or pelvic pain during a 5-year period were analyzed. Studies were included if the original radiologic reports were available for review, and if the patient underwent operative exploration. A blinded radiologist was asked to "over-read" the images. Operative findings were considered the gold standard with which radiologic reports were compared.Results: Of 322 CT and MRI studies, 125 groins met criteria. Original radiologic reports were 35% accurate, with 97% positive predictive value (PPV) and 13% negative predictive value (NPV). Over-read radiologist reports were significantly different (p < 0.0001), with 79% accuracy, 97% PPV, and 30% NPV.Conclusions: Most radiologic reports issued for CT and MRI studies were incorrect for evaluation of occult inguinal hernia. Over-read radiologist reports were more than twice as accurate when evaluating the same images. The physician who is relying on radiologic reports to determine plan of care for a patient with groin or pelvic pain should inquire further into any negative study, especially if there is strong clinical suspicion for inguinal hernia. [ABSTRACT FROM AUTHOR]

To evaluate the correlation between keratoconus and systemic manifestations of tissue hyperlaxity in the general population. In this population based cross-sectional study 940,763 medical records of Israeli adolescents and young adults in military service were reviewed. Demographic and medical data were extracted. The prevalence of ligament injuries, habitual orthopedic deformities and umbilical/inguinal hernia was evaluated in cases with and without keratoconus. The association was tested using uni- and multivariant analyses. Overall 938,411 adolescents and adults were included. Mean age was 17.55 ± 1.50 years, and 40.70% were female. Keratoconus was documented in 1,529 cases, with a prevalence of 0.16%. Compared to the general population, patients with keratoconus were significantly more likely to be diagnosed with genu varum/valgus (OR = 2.75, CI 1.48–5.13, p = 0.0015), pes planus (OR = 1.97, 95% CI: 1.62–2.38, p < 0.0001), scoliosis (OR = 1.88, 95% CI: 1.45–2.43, p < 0.0001) and umbilical/inguinal hernias (OR = 2.18, 95% CI: 1.47–3.24, p = 0.0001). On multivariate analysis the results remained significant (p < 0.05 for all). Joint injuries (ankle sprains, shoulder dislocation and injury to knee ligaments and menisci) were not significantly related to keratoconus (p > 0.05 for all). In this large cohort of adolescents and young adults, an association was found between keratoconus and connective tissue hyperlaxity manifestations involving the knees, feet, spine and abdomen. These findings suggest that keratoconus might be a manifestation of a generalized connective tissue disorder, rather than just a local ocular phenomenon. [ABSTRACT FROM AUTHOR]

Amyand's hernia (AH) is a rare type of inguinal hernia that occurs when the appendix is trapped within the hernia sac. AH accounts for approximately 1% of all inguinal hernias. However, there is currently no comprehensive review on the manifestation of AH in preterm infants. A male preterm infant, born at 31+5 weeks' gestational age with a birthweight of 1040 g, presented with a right inguinal mass at 39 days of life. The inguinal mass was firm, irreducible and erythematous. The infant also exhibited symptoms of fever and poor feeding. An abdominal X-ray showed an obstructive ileus consistent with clusters of cyst-like gas bubbles suggesting pneumatosis intestinalis. Recognizing the urgent need for intervention, emergent surgery was performed. A transverse incision along the right inguinal crease. An intraoperative exploration revealed a gangrenous appendix within the hernia which indicating AH. Herniorrhaphy and appendectomy were successfully performed without any postoperative complications. Feeding was resumed 8 days after the surgery, and the infant was discharged soon with full recovery. AH is characterized by an irreducible inguinal mass that is predominantly found on the right side in preterm infants, especially males. In less mature infants, the manifestation of AH may be more severe. Therefore, AH should be considered in the differential diagnosis of infants with abdominal emergencies, and careful intra-operative assessment is essential. AH typically requires less complex treatment and has a favorable prognosis compared to other abdominal conditions in preterm infants. [ABSTRACT FROM AUTHOR]

Right paraduodenal hernias are a consequence of midgut malrotation resulting in small bowel encased in a peritoneal-lined hernia sac posterior to the right mesocolon. An indistinct presentation often lends a difficult clinical diagnosis and identification on diagnostic laparoscopy; however, when identified, surgical repair should ensue due to a significant lifetime risk of small bowel incarceration. Two female adolescents (ages 12 and 16-years-old) were referred to Pediatric Surgery clinic for intermittent abdominal pain and frequent emesis with radiographic and endoscopic findings consistent with intestinal malrotation. Patients underwent diagnostic laparoscopy at which time a right paraduodenal hernia was identified. Repair was performed via a laparoscopic hernia reduction and laparoscopic Ladd's procedure with appendectomy. Procedure time was 96–206 minutes. There were no intraoperative or postoperative complications to date. Both patients reported near to complete resolution of abdominal pain and emesis. Laparoscopic paraduodenal hernia reduction and Ladd's procedure with appendectomy is a novel, minimally invasive approach to the repair of right paraduodenal hernia in children. [ABSTRACT FROM AUTHOR]

Inguinal ureteral and concomitant urinary bladder hernia is an exceptionally rare phenomenon. It is reported that diagnosis of urinary bladder involvement in inguinal hernias are extremely difficult to make with about only 7% of such cases being identified preoperatively. We present a case of a 70-year old man with such inguinal hernia presenting with acute scrotal hemorrhage. Our patient presented with signs of sepsis (due to urinary tract infection) and no symptoms of strangulation. Due to the high risk of developing respiratory failure during the post-operative period of a giant hernia such as the one our patient presented with, a conservative approach with creation of nephrostomy was utilized. The patient currently is being followed up and awaiting complete surgical repair. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia is a common surgical presentation. Evidence for its causation regarding occupational and recreational physical exposures is limited. The aim of this study is to conduct a systematic review objectively evaluating the evidence for a causal link between a single strenuous event and the development of an inguinal hernia.Method: A systematic review was carried out in accordance with PRISMA guidelines. PubMed, Ovid Embase, SCOPUS, and Cochrane Library were searched. In addition, the ISRCTN register, ClinicalTrials.gov, ICTR Platform, and EU Clinical Trials Register were searched. Identified publications were collated and both reviewers independently reviewed their contents.Findings: 5508 records were identified, resulting in 5 studies being selected. These 5 studies were all case series. Of 957 patients identified, 1003 hernias were described, of which 983 were inguinal hernias which 255 (26%) were attributed by patients to a single strenuous event. Only two of these studies applied Smith's Criteria (causation of a hernia from a single strenuous event): officially reported, severe pain at the time of the event, no prior history of inguinal hernia, and the diagnosis was made by a doctor within 30 days (preferably 3 days). Only 2 of 54 patients (4%) met all four criteria and so could be considered as having an inguinal hernia relating to a single strenuous event.Conclusion: Many patients associate hernias to a single episode, however upon application of more stringent criteria such as Smith's, a much smaller proportion are deemed to be actually attributable to a single strenuous event. [ABSTRACT FROM AUTHOR]

Anterior (Morgagni) congenital diaphragmatic hernia and congenital pericardial agenesis in the absence of other defects has yet to be described in a neonate. The patient was a female infant born at term to a mother with delayed prenatal care. Fetal magnetic resonance imaging at 35 weeks gestation showed a cystic lesion in the left lung base that was thought to be a variant of a congenital pulmonary airway malformation. Patient was treated with continuous positive airway pressure at birth but was stable on room air within an hour of life. Patient was asymptomatic and discharged on day 2 of life. Patient remained asymptomatic through multiple follow-ups with pediatric surgery, and imaging consistently showed a cystic mass in the lower left chest. Surgery was performed to resect the pulmonary cystic lesion 6 months after birth. Upon thoracoscopic visualization of the chest, the heart without pericardium was seen herniated into the left pleural space, and a Morgagni hernia with a cystic sac was visualized. The Morgagni hernia was repaired primarily by pediatric surgery, and pediatric cardiothoracic surgery used a Gore-Tex patch to construct the absent left pericardium. Hospital course was uneventful, and the patient was discharged on postoperative day 6. On follow-up 2 weeks after discharge, the patient was asymptomatic, but new elevation of the left hemidiaphragm was seen. Further follow-up is scheduled. The combination of defects seen in this patient has not been previously described, and further follow-up of the hemidiaphragm elevation will be necessary. Long-term complications are not expected. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernias are a significant cause of morbidity. The purpose of this systematic review and meta-analysis is to determine the totality of evidence regarding the effectiveness of local anaesthesia when compared to spinal anaesthesia in individuals undergoing open inguinal hernia repair.Methods: A systematic literature search was conducted. Inclusion criteria were randomised controlled trials (RCTs) comparing spinal and local anaesthesia on clinical and self-reported outcomes, in patients undergoing open inguinal hernia repairs. The methodological quality was assessed using the Cochrane risk of bias tool. The mode of analysis used was the difference in outcomes between the groups post-surgery and at follow-up time points. Statistical heterogeneity was assessed using the I2 statistic.Results: Ten original RCTs were included, with a total of 1379 patients. There was no significant difference in operative time between the groups [Random Effects Model, MD -0.70 min (95% CI, -5.80 to 4.40 min), p = 0.79, I2 = 84%]. Patients in the local anaesthetic group experienced significantly less pain than those in the spinal group [Fixed Effects Model, SMD -0.63 (95% CI, -0.81 to -0.46), p < 0.01, I2 = 49%], lower rates of urinary retention [FEM, RR 0.03 (95% CI 0.01-0.08), p < 0.01, I2 = 0%], decreased rates of anaesthetic failure [FEM, OR 0.17 (95% CI 0.06-0.45), p < 0.01, I2 = 0%], and increased satisfaction with the anaesthetic [FEM, OR 3.40 (95% CI 2.09-5.52), p < 0.01, I2 = 0%]. The methodological quality of studies was variable.Conclusion: Our findings support the use of local anaesthetic in adult patients undergoing open repair for a primary inguinal hernia. [ABSTRACT FROM AUTHOR]

Internal hernias are a rare but serious complication that typically present in older children and adults and can be congenital or iatrogenic in origin. They are often difficult to diagnose due to their similar radiological and clinical presentation to more common abdominal pathologies. We describe three cases of congenital internal hernias presenting in preterm infants followed by a literature review of congenital internal hernias presenting shortly after birth. When presenting in the neonatal period, congenital internal hernias have been exclusively reported as transmesenteric type. The exact etiology of transmesenteric congenital internal hernias is unclear, but may be a result of vascular compromise to the mesentery creating a small defect in which bowel may become entrapped. Certain genetic factors may also play a role in increasing risk for congenital internal hernias as they can be comorbid with other pathologies. Delayed diagnosis postpones surgical treatment, increasing risk of hernia incarceration, strangulation, irreversible bowel ischemia, and long-term risks inherent to bowel resection. Multimodal imaging plays a key role in the evaluation of these infants by excluding many causes of neonatal intestinal obstruction, however, a definitive prospective radiologic diagnosis has not been reported to date. Radiographic findings and comorbidities associated with these cases can be used along with future reported cases to potentially aid in timely diagnosis. • Congenital internal hernias presenting in neonates are difficult to diagnose preoperatively. • They often present with nonspecific findings of bowel obstruction. • Intrauterine vascular injury may be a cause of congenital internal hernia. • Multimodal imaging may aid in earlier diagnosis and decreased complications. [ABSTRACT FROM AUTHOR]

Amyand's Hernia (AH) is a rare entity described as the presence of the vermiform appendix in an inguinal hernial sac. Though its prevalence is three times more in children than adults, owing to the presence of patent processus vaginalis, its occurrence with acute appendicitis is more uncommon in children, especially in infants. Seldom diagnosed correctly ahead of surgical exploration, it is often clinically diagnosed as an incarcerated inguinal hernia or as a case of acute scrotum. The management of such cases depends upon the per-operative findings. In this series, we report four cases of AH treated at King Saud Medical City Hospital Riyadh between 2018 and 2022. All the four patients were male and three of them were infants. Three patients had right sided hernia, while one had bilateral inguinal hernia. One of the patients was diagnosed with strangulated hernia and upon exploration it was AH with acute appendicitis and appendectomy was done. One child had recurrent, irreducible hernia and upon exploration, found appendix densely adherent to the hernial sac. Another patient had early suppurative inflammation at the tip, while the patient with bilateral hernias had appendix adherent to the right hernial sac. In all our cases appendectomy was performed either due to inflammation or adhesions. There is a rarity of this condition and few cases have been reported in the literature. Such cases need to be reported to keep the surgeons aware of this condition and its different manifestations. Herein, we aim to share our experience of four cases of AH with varied presentations and a literature review. [ABSTRACT FROM AUTHOR]

The patient was an 11-month-old boy. He has been followed up at an outpatient clinic for inguinal hernia. He visited at our emergency room because of multiple episodes of vomiting. After receiving a diagnosis of incarcerated hernia, he underwent emergency surgery under general anesthesia. Intraoperative findings showed that not only the appendix but also the cecum, ascending colon, and end of the ileum had herniated, so we diagnosed him with expansive Amyand's hernia. None of the intestine was necrotic, and intestinal resection was not necessary, but there was significant ileocecal dilatation. Therefore, we resected the appendix and inserted a flexible catheter through the root of appendix to decompress the ileocecal lumen. If the ultrasound sonography at outpatient clinic had shown an appendix-like intestine with proper attention, we may have been able to diagnose him with expansive Amyand's hernia. It is crucial to check the diagnosis of hernia but also detailed contents of the hernia sac carefully by ultrasound sonography. If the appendix is confirmed with the intestine in the hernia sac, we should consider early elective surgery to avoid an emergency operation. • Amyand's hernia with herniation of the ileocecum must be diagnosed before incarceration occurs. • In inguinal hernia, we must try to detect the appendix as evidence of ileocecal herniation. • Ultrasonography at the time of incarceration shows significant edema, which often makes it difficult to detect the appendix. [ABSTRACT FROM AUTHOR]

Morgagni hernia is a rare congenital malformation accounting for less than 5% of all congenital diaphragmatic hernias. Patients may be asymptomatic or present with non-specific respiratory or gastrointestinal symptoms, which can delay the diagnose. While it is highly associated with Down Syndrome, only a few series have reported association with malrotation. The defect can be unilateral or bilateral and colon is the most frequent herniated organ. Laparoscopic assisted repair seems to be the preferable approach for repairing the defect in the last years. We present a case of a 3-year-old Down Syndrome boy that was diagnosed with a giant Morgagni hernia while investigated for reflux disease. At the time of the surgery, he was found to have a bilateral defect with herniation of small bowel, omentum, cecum, appendix, ascending and transverse colon, as well as malrotation. The defects were successfully repaired with the laparoscopic assisted technique. Malrotation was corrected at the same time. Morgagni hernia is a rare congenital disease that can be associated with malrotation, which should always be investigated at the time of surgery. The laparoscopic assisted approach is an easy and safe way to repair the defect. Malrotation when present should be corrected at the same time. [ABSTRACT FROM AUTHOR]

Study Objective: To evaluate the effectiveness of 0.125% bupivacaine compared to 0.25% bupivacaine for ultrasound-guided transversus abdominis plane (TAP) block in patients undergoing open inguinal hernia repair.Design: Randomized, double-blind study.Setting: Educational and research hospital.Patients: Forty adult patients of American Society of Anesthesiologists physical status I-III undergoing elective primary unilateral open inguinal hernia repair under spinal anesthesia.Interventions: Patients in group I received 20 mL of 0.25% bupivacaine, whereas patients in group II received 20 mL of 0.125% bupivacaine for TAP block at the end of the surgery.Measurements: Pain intensity was assessed at rest and during coughing using 10-cm visual analog scale score at 5, 15, 30, and 45 minutes and 1, 2, 4, 6, 12, and 24 hours after TAP block. Morphine consumption and time to first morphine requirement were recorded.Main Results: Visual analog scale scores at rest and during coughing were not significantly different between groups at all time points measured. Twenty-four hours of morphine consumption (7.72±7.33 mg in group I and 6.06±5.20 mg in group II; P=.437) and time to first morphine requirement (182.35±125.16 minutes in group I and 143.21±87.28 minutes in group II; P=.332) were not different between groups.Conclusions: 0.125% Bupivacaine provides similar analgesic effect compared to 0.25% bupivacaine for ultrasound-guided TAP block in patients undergoing open inguinal hernia repair. [ABSTRACT FROM AUTHOR]

Hydrocele of the canal of Nuck is a rare condition in female children caused by a failure of complete obliteration of the canal of Nuck. The canal of Nuck is an abnormal patent pouch of the peritoneum extending anterior to the round ligament of the uterus into the labia majora. Incomplete obliteration of this canal (patent processus vaginalis) can result in either an inguinal hernia or a hydrocele. Here, we report two cases of hydrocele of the canal of Nuck presented within a two-month period. In the first case, incarcerated right-sided inguinal hernia was suspected while the second case was clinically diagnosed as encysted hydrocele of canal of Nuck. Both patients underwent surgical exploration. Hydrocelectomy with high ligation was also performed. One month after the surgery, the first patient showed signs of hydrocele on contralateral side, while the other patient showed no sign of contralateral hydrocele or hernia. [ABSTRACT FROM AUTHOR]

An Amyand's hernia is an unusual diagnosis in children and even rarer in neonates. Perforation of the appendix inside the hernia sac is also extremely unusual. The diagnosis of an Amyand's hernia is difficult as presenting symptoms can also be attributed to an isolated inguinal hernia, noncommunicating hydrocele, or testicular torsion. We present a case of an Amyand's hernia with perforated appendix and scrotal abscess in a premature newborn. [ABSTRACT FROM AUTHOR]

Paraduodenal hernia (PDH) is considered the most common type of internal hernia. It accounts for 50% of the internal hernias , which occurs due to failure of the parietal peritoneum to fuse with part of the dorsal mesentery, causing a fossa in the mesocolon. PDH is a rare cause of intestinal obstruction with an unknown incidence in the pediatric population. We present a case of a seven-year-old female patient who presented with non-specific abdominal pain and progressive bilious vomiting for three days. The preoperative diagnosis of the left preduodenal hernia was achieved based on CT findings. The patient underwent laparoscopic repair using a conventional approach. Diagnosis of PDH in pediatric patients requires a high index of suspicion due to the broad spectrum of clinical presentation. Laparoscopic treatment seems to be an efficient and highly effective approach in uncomplicated PDH, resulting in a short length of stay and a fast return to the regular diet. [ABSTRACT FROM AUTHOR]

We describe a case of an unusual lateral congenital abdominal wall hernia. This male patient was born with a constellation of anomalies including a Spigelian-like left lower quadrant abdominal wall hernia, right tibial hemimelia, left hip dysplasia with dislocation, cleft palate and cryptorchidism. At three months of age, the patient underwent a diagnostic laparoscopy, right inguinal hernia repair, left lower quadrant abdominal wall hernia repair, and bilateral orchiopexy to manage these defects. [ABSTRACT FROM AUTHOR]

Acquired inguinal herniation is a very common condition in stallions, usually leading to unilateral or bilateral castration to prevent future recurrence. Recently, several surgical techniques such as the standing laparoscopic peritoneal flap hernioplasty (SLPFH) have been developed to avoid herniation recurrence and also preserve the breeding activity of high economic value stallions. However, studies on SLPFH lack more comprehensive and systematic data about reproductive-related adverse effects and outcomes. The aim of this study was to evaluate whether SLPFH of the internal inguinal rings produces changes in the testicular blood flow in a 1-year follow-up. For that purpose, six healthy stallions were used and testicular blood flow was assessed before, 3, 6, and 12 months (T0, T3, T6, and T12) after the procedure. Blood flow was evaluated ultrasonographically, using the pulsed-wave color Doppler mode. Peak systolic velocity, end-diastolic velocity, the time-averaged maximum velocity, and the derived indexes (resistive index) and pulsatility index) of the testicular artery were measured in two localizations: in the spermatic cord and on the caudal epididymal edge of the testicle. On the spermatic cord, the peak systolic velocity of the testicular artery increased significantly at T12. However, on the epididymal edge location of the artery, the pulsatility and resistive indexes were decreased at T12 (P < 0.05). This pattern of blood flow was related to a hyperemic process. Furthermore, SLPFH might have compressed the spermatic cord, causing a slight occlusion of the testicular artery and triggering a compensatory hyperemia to compensate the deficit of blood flow that supplies the testes. The SLPFH of the internal inguinal ring affected the testicular perfusion in stallions in a 1 year follow-up, although there was no effect on sperm production during this time. The spectral Doppler ultrasound is a useful tool to asses the testicular perfusion after reproductive surgical procedure and provides information which anticipates vascular supply compromise of the stallion testicles. [ABSTRACT FROM AUTHOR]

1 Preoperative CT scan (coronal and sagittal views) showing the distended ureter (fat arrow) descending into the scrotum and the sigmoid colon (thin arrow) partially obstructed into the hernia sac Graph: Fig. After initial fluid resuscitation, a CT scan revealed a giant, wide-necked left inguinoscrotal hernia containing chronically obstructed left ureter and sigmoid colon. 2 Preoperative CT scan (axial view) showing the distended ureter (fat arrow) and the sigmoid colon (thin arrows) in the hernia sac Discussion Inguinoscrotal hernias are common surgical problems. [Extracted from the article]

We present a healthy adolescent male with no past surgical history who presented with acute onset abdominal pain. Cross-sectional imaging was concerning for possible ileocecal intussusception, and repeat imaging demonstrated an internal hernia. The patient was taken to the operating room for exploration. He was discovered to have an ileocecal intussusception with a large cecal mass, as well as a left paraduodenal hernia. Closure of the mesenteric defect and ileocecectomy with primary anastomosis were performed. Pathology of the mass was consistent with colonic lipoma. Postoperatively, he had slow return of bowel function, but his recovery was otherwise uncomplicated. This case reports a rare presentation of concomitant ileocecal intussusception due to a cecal lipoma and congenital internal hernia. Intussusception in the pediatric population is typically idiopathic, and intussusception with a pathologic lead point is far more common in adults. Gastrointestinal lipomas are also uncommon in pediatric patients, and when discovered are generally small and asymptomatic. Internal hernias most commonly are due to acquired mesenteric defects or adhesive disease, though may present congenitally as seen in this patient. This case is unique because of the simultaneous occurrence of two separate surgical problems, both with atypical etiologies based on patient history and demographics. [ABSTRACT FROM AUTHOR]

Congenital diaphragmatic hernias (CDH) occur when the diaphragm fails to close during normal fetal development. The most common subtypes are Bochdalek and Morgagni hernias. There are a variety of presentations from asymptomatic to severe cardiopulmonary compromise present at birth. Presented is a case of a six-day-old neonate with a postero-central diaphragmatic hernia with herniated liver causing right atrial compression and right-to-left shunting across the patient's patent foramen ovale (PFO). The hernia was repaired with a laparoscopic patch technique. [ABSTRACT FROM AUTHOR]

A 9-year-old boy was referred to us with an acute pain attack of the left scrotal contents. Ultrasonography showed a normal blood supply to the left testis, suggesting an incarcerated left inguinal hernia. Surgical exploration did not demonstrate an incarcerated left inguinal hernia. After exploration of the left testis, a dark red pedunculated cystic mass, separate from the left testis, was found to be twisted. Immunohistochemical studies of the excised cyst demonstrated torsion of the hernia sac of the peritoneum. In conclusion, we encountered a case of acute scrotum which was probably caused by torsion of the hernia sac. [ABSTRACT FROM AUTHOR]

Meckel's diverticulum (MD) is congenital malformation that usually asymptomatic. MD could be emergency cases in pediatric due to the complication. We report an interesting and rare case complication of MD in 5 years old children who presented with internal hernia and intestinal volvulus. The type ectopic epithelium that we have identified is an ectopic pancreatic tissue in the histopathology examination of MD resection tissue. Post-operative course, the patient got full recovery. Symptomatic MD can be present as the complication that can be severe emergency cases. Complication MD that we found is intestinal volvulus with the exceedingly rare associated case of internal hernia. [ABSTRACT FROM AUTHOR]

Pediatric inguinal hernias are a very common diagnosis encountered by pediatric surgeons with an overall incidence of 1–4% in all infants. In rare cases, a fluid filled cyst may be encountered in the inguinal canal, known as a hydrocele. We present the case of a 4-year-old female who presented with an incarcerated inguinal hernia containing a hydrocele which was subsequently removed. [ABSTRACT FROM AUTHOR]

Amyand hernia (AH) is defined as protrusion of appendix or its entrapment within the inguinal hernia sac. It occurs rarely and difficult to diagnose before operation. The cause of amyand hernia is unknown but pressure by the sharp edge of the internal ring may cause pressure necrosis, inflammation and consequently appendicitis. We present a case of 3 years old child with asymptomatic right sided inguinal hernia. On exploration, we found a long appendix (10 cm) with small olive like (1.5 cm) mass at its tip, so we performed appendectomy along with herniotomy. The patient tolerated the operation well and was discharged with satisfactory condition 48 hours post-operation. [ABSTRACT FROM AUTHOR]

B Conclusion: b Refractory ascites requiring pre-operative paracentesis and /or drain placement was a major risk factor for hernia recurrence when controlling for Na-MELD score in this high-risk population. Moreover, elective surgeries for hernias prevented potential downstream complications with very low mortality allowing eligible patients to eventually receive a liver transplant. [Extracted from the article]

We report a case of a 4-week-old female presenting with congenital bilateral flank hernias. The patient was born at term and was found to have large bilateral flank bulges. Although her hernias were asymptomatic, bilateral lower extremity jerking movements prompted further workup which revealed thoracolumbar spinal cord dysraphism. No other congenital anomalies were identified. Given the low risk of incarceration, repair was delayed until 9 months of age. At operation, complete bilateral agenesis of the oblique and transversus abdominus musculature was found. Open repair was performed with bilateral latissimus dorsi rotational muscle flaps and biological mesh. Congenital flank hernias are extremely rare with few cases reported in the literature. While they can appear externally similar to the more widely reported congenital lumbar hernia, the herniation through the absent oblique and transversus musculature makes this case anatomically distinct. The exact etiology of congenital flank hernias is unclear, although given the presence of associated congenital anomalies, migrational failure during embryogenesis represents a likely culprit. Surgeons approaching this pathology should understand the importance of a thorough multidisciplinary evaluation for associated anomalies prior to operation and be familiar with complex hernia repair techniques such as rotational flaps. [ABSTRACT FROM AUTHOR]