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• For long-term benefit to result from cytoreductive surgery, all visible disease must be removed. • Peritoneal metastases obscured from visible detection by the surgeon will not be resected. • Peritoneal tunnels in the inguinal and porta hepatis regions were identified. • For optimal cytoreduction, peritoneal tunnels must be opened and tumor resected. Peritoneal metastases from gastrointestinal cancer can be treated by a combination of surgery to remove visible evidence of disease and perioperative intraperitoneal chemotherapy to eradicate microscopic disease. Complete cytoreduction is necessary for long-term benefit. Two sites for incomplete cytoreduction because tumor is hidden from visual inspection were identified. Patients who developed recurrence at these anatomic sites were studied. A peritoneal tunnel along a patent processus vaginalis allowed tumor to be sequestered along the inguinal canal in a female patient. A peritoneal tunnel beneath a hepatic bridge over the round ligament obscured mucinous tumor in a male patient. Peritoneal tunnels in the inguinal region or at the porta hepatis should be opened by surgical dissection so that all foci of peritoneal metastases are removed at a complete cytoreductive surgery and these sites treated with chemotherapy. [ABSTRACT FROM AUTHOR]

Abstract The canal of Nuck is the female equivalent of the processus vaginalis in the male but is less well known than its male counterpart. It is a rare entity not commonly encountered by radiologists, particularly in the adult population. Knowledge of the embryology and anatomy of the canal of Nuck is essential for identification of the various pathologic conditions that may occur in this location. Moreover, radiologists should be familiar with this entity to compose an appropriate and thorough differential diagnosis of a labial mass/swelling. In this review, we discuss both the anatomy and the more common pathology that can be encountered within it. Highlights • The canal of Nuck is the female equivalent to a patent processus vaginalis in the male. • The term canal of Nuck as well as the anatomy of it is not well known by radiologist or surgeons. • There are a variety of normal structures and possible pathologic findings that can be found in this anatomic region. • Understanding the anatomy and embryology of the canal of Nuck is essential for interpretation of the radiologic findings. [ABSTRACT FROM AUTHOR]

Highlights • Bladder hernias are rare incidents that are mostly discovered intraoperatively. • Diagnosis must be made preoperatively to avoid risk of injuring the bladder. • High index of suspicion for bladder hernia is vital in elderly males with urinary or intestinal symptoms. Abstract Introduction Inguinal bladder hernias are rare incidents accounting for 1–3% of all inguinal hernia. Most of those cases are discovered intraoperatively accounting for the high incidence of bladder injuries during the repair. Symptoms can be variable depending on the size of the herniated bladder. Presentation of case We present here a 70 years old obese male patient, with history of CVA & on regular Aspirin ingestion. He presented to the ER as a case of intestinal obstruction due to suspicion of strangulated inguinal hernia based on an unclear Ultrasound picture. He underwent an emergency exploration of the hernia where the balloon of a Foley's catheter was found inside a diverticulum of the urinary bladder, herniated through an Ogilvie hernia. Discussion Ogilvie hernia is a rare incident that happens mostly in elderly males. The herniated part contains prevesical fat, bladder andor loops of intestines. Diagnosis must be made preoperatively through CT scan or Cystourethrogram. First line management involves surgical reduction of the bladder and hernia repair. Resection of the herniated part is generally limited to necrotic tissues. Conclusion Surgeons must have high index of suspicion for elderly obese males with inguinal hernias and urinary or intestinal obstruction symptoms. Careful preoperative planning must be made to avoid repair associated bladder injuries. [ABSTRACT FROM AUTHOR]

Abnormalities in the inguinal region are varied. The most common abnormality in the inguinal region is the hernia: direct or indirect inguinal hernia and femoral hernia. There are many hernia-mimicking lesions, such as spermatic cord hydrocele, undescended testis, hematoma, inflammation, abscess, benign or malignant tumors, metastatic or benign lymph node enlargement, round ligament varicosities or mesothelial cyst, and herniated ovary. Ultrasonography is currently the primary imaging modality used in assessing inguinal lesions and helpful for the differential diagnosis of a broad spectrum of these diseases. Familiarity with clinical setting and certain ultrasonography details will facilitate prompt and accurate diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Résumé Le diagnostic de pubalgie du sportif est difficile et impose d’avoir d’abord éliminé une pathologie uro-génitale ou digestive. Des déséquilibres entre les muscles obliques de l’abdomen et adducteurs, ou entre adducteurs et abducteurs de hanche, semblent au cœur de sa physiopathologie, mais celle-ci reste encore discutée. L’examen programmé du pubis permet d’évaluer la douleur, les amplitudes des hanches, la mobilité du rachis, et de mesurer la force des muscles en particulier celle des adducteurs et abdominaux (grands droits et obliques). La présence d’une hernie inguinale incite à une solution chirurgicale. Les douleurs isolées du canal inguinal doivent être soigneusement distinguées d’autres douleurs musculo-tendino-osseuses souvent intriquées, grâce surtout à la clinique, même si l’IRM paraît incontournable chez le sportif de haut niveau. Le traitement dépend des déficiences musculaires et articulaires. Il consiste en exercices de gain d’amplitude articulaire de hanche et/ou de renforcements musculaires analytiques, visant à redonner une dynamique au pubis et à permettre la reprise d’efforts infra-douloureux. La progression doit se faire étape par étape sans focaliser sur la durée d’indisponibilité sportive afin d’éviter les récidives, ou le passage à la chronicité. Si le traitement est bien conduit, la reprise du sport au même niveau est possible dans un délai de 3 mois dans 80 % des cas. Dans les formes rebelles, une indication chirurgicale de réparation des murs du canal inguinal peut être posée, qui donne de bons résultats dans 65 à 95 % des cas. Une prévention secondaire est nécessaire pour préserver les équilibres musculaires du pubis. Groin pain in sportsmen corresponds to a difficult clinical diagnosis which imposes first of all to eliminate uro-genital or digestive diseases. Physiopathology remains badly known even if the role of muscular imbalances between the rectus/obliquus abdominis and/or hip adductors/abductors is favored. The scheduled examination of the pubis allows to evaluate pain, the hips and back range of motion, and to measure the muscular force in particular of hip adductors and abdominal muscles (rectus and obliquus abdominis). If inguinal hernia may lead to surgical procedure, isolated pain of the inguinal canal must be carefully distinguished from other muscular-tendinosis-bone's pains. Clinical examination allows the diagnosis, even if MRI is a key imaging in the high-level sportsman. Treatment is based on the muscular and joint deficiencies analysis. It consists of hip range of motion gain and/or analytical muscular strengthening to restore the dynamics of the pubic joint and to allow the resumption of infra-painful sport training. Progress has to be made step by step. Indeed sport should not be resumed to early since recurrence of pain or even chronicity of pain would occurr. According to well-managed treatment, sport resumption at the same level is possible within 3 months in 80% of cases. When rehabilitation fails, a surgical indication to repair the different walls of the inguinal canal can be suggested with good results in 65 to 95% of cases. Secondary prevention must be set up to keep muscular balances of the pubis. [ABSTRACT FROM AUTHOR]

Introduction A large number of complications are reported with the use of IUD. Migration to inguinal region has not been mentioned in literature. We report a rare case of migrated IUD to inguinal canal. Case report A 25-year-old lady presented with a painfull mass in the left inguinal region. Diagnostic work up showed migrated IUD to inguinal region. Operation was done and the impacted IUD with surrounding granuloma was retrieved. Discussion When the string of the IUD is no longer visible at the external os of the cervix, radiological scan must be performed, this should begin with a sonographic examination and plain abdominal radiography may be used to localize the IUD. Conclusion IUD Migration may occur to unusual area and perforation can be misdiagnosed as non-witnessed expulsion. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the management and outcomes of pediatric patients presenting with torsion of an undescended testis in the inguinal canal. Patients and methods: The case records of 84 children operated on for testicular torsion were retrospectively reviewed. The medical records included initial medical history, physical examination, operative findings, and the results of follow-up. The diagnosis of torsion of undescended testis was made clinically and confirmed by a Doppler ultrasound and inguinal canal exploration. Results: Eight children were operated following torsion of undescended testis. In four cases the testicle was preserved and orchidopexy was performed, while in four cases orchidectomy was performed due to testicular gangrene. Mean duration of symptoms, at time of surgery, in the orchidopexy group was 6 h and in the orchidectomy group was 50 h. At follow-up atrophy of the testis was found in only one patient. Conclusion: Torsion of an undescended testis is a relatively rare phenomenon that should be suspected, diagnosed and treated without delay. This study highlights the importance of examination of external genital organs. With improved recognition of this entity and earlier referrals of patients with undescended testes by primary care physicians, its occurrence might eventually be prevented. [Copyright &y& Elsevier]

Résumé: La pubalgie est une pathologie fréquente chez le sportif mais sa prise en charge reste pourtant un challenge. Sur le plan international, les terminologies s’harmonisent peu à peu et une volonté de créer des examens cliniques sensibles, spécifiques et reproductibles ainsi que des moyens de suivi thérapeutique validés émerge et devrait permettre la publication de travaux de plus haut niveau de preuve dans un proche avenir. Cette région anatomique est complexe et la physiopathologie reste discutée. Le diagnostic de pubalgie est un diagnostic d’élimination qui est posé suite à une démarche diagnostique rigoureuse. Quatre grandes entités anatomiques sont regroupées sous le terme de pubalgie. Cette dernière, dans de nombreux cas, présente une forme associée et le clinicien s’attache à proposer une cartographie précise des sites lésionnels. Il guide ainsi la prise en charge de rééducation qui est le plus souvent le traitement de première intention. Enfin par un suivi régulier, il évalue l’évolution des symptômes et opte si nécessaire pour un traitement chirurgical en cas d’échec ou de lésions ne répondant que partiellement au traitement conservateur. Une prise en charge multidisciplinaire centrée sur l’athlète permet un retour aux activités physiques sans douleur après plusieurs mois. [ABSTRACT FROM AUTHOR]

Abstract: This article describes, in a systematic manner, the anatomy of the anterior abdominal wall, with emphasis being placed on clinical and surgical aspects. This knowledge should help the reader understand the anatomical basis to various laparotomy incisions. Also described in this article is the anatomy of the inguinal canal and inguinal herniae and the anatomical distinction between direct and indirect inguinal herniae. [Copyright &y& Elsevier]

Abstract: Saphenous varix is a rare vascular malformation occurring in the groin and its recognition may pose a diagnostic challenge. This paper highlights the importance of differentiating saphenous varix from femoral hernia amongst a wide range of possible groin masses, using ultrasound as a front-line imaging modality which clinical examination could not diagnose. We present a case report of a 39 year old male patient with saphenous varix, a sacculated varix of the greater saphenous vein closely simulating femoral hernia. Our report highlights the key points to note in correctly diagnosing this rare condition and the role of ultrasound as a cheap, non-invasive and readily available modality. [ABSTRACT FROM AUTHOR]

Abstract: A 20-year-old man presented with a 1-year history of right inguinoscrotal swelling. Ultrasonography revealed a solid hipoechoic well-demarcated mass separated from the testis and epididymis. No communication between the mass and the peritoneum was seen. Doppler US examination showed no vascularity in the mass. The mass was isointense with muscle on T1-weighted magnetic resonance images, marked hypointense on T2-weighted MR images and enhanced after contrast administration. The mass was removed surgically. Pathological examination revealed a solitary fibrous tumor (SFT) of the spermatic cord. To our knowledge, imaging findings of an inguinal SFT was not reported before. [Copyright &y& Elsevier]

Abstract: The rectus abdominis occupies two-thirds of the anterior abdominal wall and is contained with the rectus sheath, made up of the aponeuroses of the lateral muscles – the external and the internal oblique and the transversus abdominis. The mid-line is marked by the linea alba and the lateral edge of rectus by the linea semilunaris. The rectus sheath is fused anteriorly to muscle but is free posteriorly, and contains the inferior and superior epigastric vessels. The space between rectus and the posterior sheath allows local anaesthetic to travel in this plane when performing a rectus block. The abdominal wall is innervated by the anterior primary rami of T7 to L1, T10 supplying the level of the umbilicus. The inguinal canal is the oblique passage taken through the lower abdominal wall by the testis and spermatic cord in the male and by the round ligament in the female. It also transmits the ilioinguinal nerve (L1). It is a point of potential weakness in the wall and is the site of direct and indirect ingunal hernias, which can be defined by their relationship to the inferior epigastric vessels. These lie medial to the neck of an indirect hernia, which passes through the internal ring of the canal, while a direct hernia, passing directly through the posterior wall of the canal, lies lateral to the vessels. [Copyright &y& Elsevier]

Introduction Hydatid disease is a common health problem in developing countries and liver and lungs are the most commonly involved organs. Hydatid cyst in inguinal canal is very rare and no case in children has been reported in literature. Presentation of case We describe a four year male child with right inguinal swelling with occasional pain and gradually increase in size. The diagnosis of lipoma of the cord was made. Up on inguinal exploration, coincidently Hydatid cyst was detected. Postoperatively histopathological examination (HPE) of the cyst confirmed the diagnosis of Hydatid disease and patient was put on albendazole therapy for three months. Discussion Hydatid disease is very rare in the inguinal canal and no case in children has been reported. In adults fewer than five cases has been reported and is usually coincidently detected during surgical exploration, as was in our case. Ultrasonography, CT, MRI and other serological tests may help in pre-operative diagnosis. Conclusion In endemic areas, patients with progressive enlarging groin swelling, possibility of Hydatid cyst should be kept in mind and should be operated as early as possible. [ABSTRACT FROM AUTHOR]