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75 years was referred from SMHS hospital as a case of left-sided irreducible inguinal hernia. The patient was a known case of rheumatic heart disease on multiple drugs. The patient was having a history of constipation for 4 days and mild pain lower abdomen. All investigations were within normal limit and patient was afebrile. The abdomen was soft, nondistended. There was mild tenderness over the right inguinal region and a soft boggy swelling was palpable. It was nonreducible. JMS 2018;21(1):47

Posttraumatic reconstruction of large lower extremity veins is a challenging and rarely performed procedure. We describe a case of an 18-year-old male traffic accident victim presenting with extensive venous injury of the right inguinal region including external iliac vein and common femoral vein requiring immediate ligation. Owing to life-threatening phlegmasia cerulea dolens, venous reconstruction was successfully performed using an femoral vein interposition autograft from the contralateral lower limb.

Accidental radioisotope burns are rare. The major components of radiation injury are burns, interstitial pneumonitis, acute bone marrow suppression, acute renal failure and adult respiratory distress syndrome. Radiation burns, though localized in distribution, have systemic effects, and can be extremely difficult to heal, even after multiple surgeries. In a 25 year old male who sustained such trauma by accidental industrial exposure to Iridium192 the early presentation involved recurrent haematemesis, pancytopenia and bone marrow suppression. After three weeks he developed burns in contact areas in the left hand, left side of the chest, abdomen and right inguinal region. All except the inguinal wound healed spontaneously but the former became a non-healing ulcer. Pancytopenia and bone marrow depression followed. He was treated with morphine and NSAIDs, epidural buprinorphine and bupivicaine for pain relief, steroids, antibiotics followed by wound excision and reconstruction with tensor fascia lata(TFL) flap. Patient had breakdown of abdominal scar later and it was excised with 0.5 cm margins up to the underlying muscle and the wound was covered by a latissimis dorsi flap. Further scar break down and recurrent ulcers occurred at different sites including left wrist, left thumb and right heel in the next two years which needed multiple surgical interventions.

A 53-year-old man presented for a surveillance 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT following recent resection of a melanoma of his right leg and metastasis to his right inguinal region. The scan was acquired approximately 60 min after intravenous injection of FDG. The FDG-PET/CT scan demonstrated no FDG uptake in the right inguinal region. However, intense FDG uptake was observed in skeletal muscles, specifically in the left foot (figure 1A) and around the shoulder, bicep and pectoral regions bilaterally (figure 1B,C). Figure 1 18F-fluorodeoxyglucose positron emission tomography showed intense uptake within the left foot (A) and around the shoulder (B), bicep and pectoral regions bilaterally (C). FDG-PET/CT is an integral part of modern-day practice in oncology imaging …

Background : Axial pattern flaps use direct cutaneous arteries to enable closure of a skin defect using a large skin segment. Caudal epigastric axial pattern flaps are highly versatile owing to their wide arc of rotation, which includes the preputial area. The presence of abundant loose and elastic skin allows wider flaps. Hemangiosarcoma (HSA) is a malignant neoplasm of endothelial cells with aggressive local behavior and high metastatic rate; the lungs are the most common site of metastasis. This case report aims to describe the use of a caudal epigastric artery-based flap, with preservation of some cranial epigastric artery branches for penis sparing, following resection of a hemangiosarcoma in the right inguinal region of a male dog. Case : An eight-year-old male Pitt Bull dog was referred with a 15 cm, ulcerated hemangiosarcoma in the right inguinal region, near the prepuce. A similar tumor had been removed from the same location two years before. Previous treatment with oral prednisone did not provide satisfactory results. The patient was suffering from intense chronic blood loss and bacterial infection of the tumor tissue. Thoracic radiographs revealed multiple metastatic nodules. Only mild regenerative anemia was found in blood tests. Considerable reductions in tumor size and in the ulcerated surface, decrease in bleeding, and recovery of appetite were observed after 7 days of administration of piroxicam and cephalexin. Surgical resection of the tumor was performed as a palliative treatment with a minimal safety margin of 2 cm, which spared the penis. An epigastric skin flap incorporating the second mammary gland was performed preserving branches of cranial epigastric arteries, and was rotated 160° to cover the defect created in the right inguinal region and on the body of the penis. A small suture dehiscence, necrosis of the distal border of the flap, seroma, and multidrug-resistant Escherichia coli infection were observed in the postoperative period. Administration of penicillin V and topical collagenase, placement of a passive drain, and a second surgical procedure to correct the dehiscence were necessary to solve postoperative complications. Piroxicam based metronomic chemotherapy was maintained continuously, as the patient would exhibit worsening of overall condition upon discontinuation of medication. One hundred days after the initial presentation, the animal was euthanized owing to the presence of an osteolytic lesion on the vertebral bodies of L3-L4 and L5-L6, which were suggestive of discosponlylitis or axial bone metastasis. Discussion : Since lung metastases were present, penectomy and uretrostomy were not considered an option, and a pallia tive surgical treatment was performed. In this case report, cranial and caudal epigastric flap presented few complications. Caudal epigastric blood vessels are robust and abundant. Distal necrosis was considered a minor complication and was in accordance with others reports. The multidrug resistant infection was considered a nosocomial infection that arised from a long hospital stay. By inhibiting cyclooxygenase, piroxicam decreases angiogenesis, increases apoptosis, and prolongs disease-free intervals with mild toxicity. An excellent response to preoperative administration of piroxicam was crucial when choosing the postoperative protocol. A signifcant tumor size reduction and a decrease in chronic bleeding associated to improvement in general health were observed with the piroxicam-based treatment. To our knowledge, this is the frst report of a mixed (cranial and caudal) epigastric artery skin flap. This type of flap was considered a good option for correction of large defects in the inguinal region and for preservation of the prepuce and penis. Keywords: hemangiosarcoma, cranial, caudal, penis, sparing.

Incarcerated inguinal hernia is one of the emergency operations for delay diagnosis may cause serious dreadful effects such as bowel obstruction, bacterial translocation with sepsis, intestinal wall necrosis, bowel perforation, or even death. On the other hand, inflammatory pseudotumors (IPTs) were first described by Brunn, but their cause remains unknown. These benign lesions are common in children and young adults, but they can also occur in elderly adults. An 88-year-old Chinese man was referred to our hospital with a painful mass in his right inguinal region for 3 days. The patient complained about abdominal fullness, poor appetite, and right groin painful and an enlarged lesion in his groin site since five days ago. Physical examination revealed a tender, painful, untouchable, and nonpulsatile mass lesion in the right groin area. Non-specific bowel gas and stool impaction in the KUB. Ultrasound and color Doppler images showed a laminated and well-defined mass on the right inguinal region with a hypoechoic center without blood flow signals and increased peripheral vascularity, which was similar to a bowel loop through the inner ring into the inguinal canal. Computed tomography revealed a soft tissue mass-like lesion in right inguinal area. We performed an emergent exploratory laparotomy under a tentative diagnosis of an incarcerated hernia, but just found a mass in the hernia sac during the operation. Histopathologic examination showed typical findings of the IPT. The patient was followed for 6 months without evidence of local recurrence or distant metastasis. As it is nearly impossible to make a correct judgment prior to operation, surgical resection is usually required for diagnosing IPTs.

A 2-year-old double yellow-headed Amazon parrot (Amazona ochrocephala oratrix) was presented for evaluation of a mass on the left wing. A second soft tissue swelling was present under the left mandible and a third in the right inguinal region. The bird had pale mucous membranes, but no other abnormalities were observed on physical examination. Results of the complete blood count and plasma biochemical profile were anemia and decreased total solids. Cytologic findings from fine needle aspirates of the 3 affected areas were nondiagnostic. Whole-body radiographs revealed focal soft tissue swellings. Doppler ultrasound demonstrated significant vascularity in the inguinal swelling; therefore, biopsy of the area was considered contraindicated. Because of the rapid and extensive progression of disease, the owners elected euthanasia. Gross postmortem examination revealed marked and generalized skin thickening. The spleen was slightly enlarged and the bone marrow prominent and gelatinous. The histologic diagnosis was lymphosarcoma, which involved the skin, spleen, and bone marrow. Immunohistochemistry results were consistent with lymphosarcoma of T-cell origin. This case presents an unusual cutaneous manifestation of lymphosarcoma in an Amazon parrot.

Background: Intranodal palisaded myofibroblastoma (IPM) is a rare, lymph node mesenchymal neoplasm; the cytologic features are limited in the literature. Case: The patient was a 51-year-old female who had a firm, palpable mass in the right inguinal region. Fine-needle aspiration (FNA) was performed. The smears revealed large, 3-dimensional clusters of cohesive spindle cells, densely surrounding a central, orange-colored, acellular matrix core. These cells had a single, elongated nucleus and an inconspicuous nucleolus. Also seen were spindle cells in short fascicles with dense cytoplasm. The spindle cells were loosely arranged in a single-cell pattern. In addition to the spindle cells and matrix, hemosiderin granules were scattered in the background. A few lymphocytes were identified. Conclusion: A diagnosis of IPM should be considered when FNA smears of lymph node show bland spindle cells in various patterns including single cells, short fascicles, large cohesive clusters with core amianthoid fibers and background hemosiderin granules.

Introduction: Femoral hernia (FH) is extremely rare in children, comprising 0.1%–0.9% of all inguinal region hernia repairs, as reported in the prelaparoscopic era.1,2 In centers where inguinal hernia (IH) is treated laparoscopically, FH was diagnosed in 1.1%–2.8%,1,2 suggesting a higher actual prevalence. Many cases are diagnosed perioperatively or discovered only when an IH recurrence occurs.3 We propose a laparoscopic approach to close the femoral ring, according to McVay's principles.4 Materials and Methods: A 4-year-old boy was referred to our service for IH. His parents and the pediatrician observed a recurring bulging in the right inguinal region. On examination, the bulging appeared below and laterally to the pubic tubercle while the boy was straining, but quickly reduced spontaneously. The child was scheduled for a laparoscopic reparative operation of a FH. A 5-mm 30° scope placed in the umbilicus, two 3.5-mm trocars placed in both flanks, and CO2 insufflation at 8 mm Hg were used. On in...

An 8-year-old boy presented with voiding from the right inguinal region, which on evaluation was diagnosed as prostato-inguinal fistula. We discuss the pathophysiology of this fistula.

Inflammatory myofibroblastic tumors (IMTs) of the inguinal region are exceptionally rare. The current study reported the case of a 49 year-old male patient with IMT, who presented with a fever, night sweats, anorexia, loss of weight and frequent urination. Computed tomography (CT) revealed a lesion occupying the soft tissue of the right inguinal region and surgery was performed to resect the lesion. Histopathological analysis of the lesion revealed a composition of spindle and inflammatory cells, including plasma cells and lymphocytes. In addition, immunohistochemical analysis demonstrated that the tumor cells were positive for CD34, vimentin, actin, Ki-67, B cell lymphoma-2, CD99, epithelial membrane antigen and CD38; however, tumor cells were negative for CD117, desmin, anaplastic lymphoma kinase and creatine kinase. Thus, the patient was diagnosed with IMT and was advised to return for regular follow-up appointments. Subsequently, the patient developed a local recurrence 12 months following the initial surgery. Of note, the histopathological characteristics of the recurrent lesions were consistent with those of the initial specimen. Thus, a second surgery was performed, followed by fractionated radiotherapy (FRT). At 3 and 6 months following the FRT, magnetic resonance imaging scans did not indicate tumor recurrence or metastasis. In conclusion, surgical excision is the current recommended treatment for IMT; however, for cases similar to that of the current study, which are not successfully controlled by surgical excision, radiotherapy should be considered and long-term follow-up is essential.

A 62-year-old Chinese man presented with a painless swelling in the right inguinal region that had been increasing in size for over a year. After ultrasound imaging, a provisional diagnosis of a spermatic cord lipoma was made, and the inguinal mass was excised. The histological examination revealed a well differentiated liposarcoma with involved margins. The patient was referred to a urologist at our institution for further management. On examination, a right inguinal scar was noted over a 7-cm swelling in the right inguinal region. The right testis was firm, enlarged, and fixed to the surrounding right hemiscrotal skin. Surgical resection of the right inguinal region and the right hemiscrotum, in combination with right orchidectomy, resulted in a 20×8-cm skin defect and a 5×3-cm anterior abdominal wall defect involving the external oblique aponeurosis, internal oblique muscle, and conjoint tendon, and extending along the inguinal canal (Fig. 1). A contralateral oblique rectus abdominis myocutaneous (ORAM) flap was raised based on the left deep inferior epigastric vessels. The inguinal fascial defect was reconstructed with the size-matched anterior rectus sheath of the ORAM flap by sequential mattress stitching that opposed the edges of the inguinal fascial defect to the rectus sheath of the flap (Fig. 2). The skin and subcutaneous defect were closed with a skin paddle. Excess length at the distal end of the skin paddle was de-epithelised and folded onto itself to obliterate the potential hemiscrotal dead space and create fullness in the scrotum after the orchidectomy (Fig. 3). An inlay prolene mesh was used to reconstitute the defect in the donor site rectus sheath followed by meticulous closure of soft tissue and the skin in layers. The patient had an uncomplicated recovery. A follow-up examination three months later showed that his wounds had recovered well, with good aesthetic results (Fig. 4). Clinical and radiological investigations did not show any recurrence or complications, such as inguinal hernia (Fig. 5). Fig. 1 Surgical resection of the right inguinal region and the right hemiscrotum, together with right orchidectomy, resulted in a 15×7-cm skin defect and a 5×3-cm anterior abdominal wall defect involving the external oblique aponeurosis, internal ... Fig. 2 The skin and subcutaneous defect were closed with the oblique rectus abdominis myocutaneous) skin paddle and the excess length at the distal end of the skin paddle was de-epithelised and folded onto itself to obliterate the potential hemiscrotal dead ... Fig. 3 This schematic figure shows how the oblique rectus abdominis myocutaneous flap was tunnelled and folded over, so that the anterior rectus sheath in the flap was used to reconstruct the fascial component of the inguinoscrotal defect. Fig. 4 This figure contains a frontal view three months after the operation showing that the wounds had healed well and that a good aesthetic result was achieved. Fig. 5 This figure contains a lateral view three months after the operation showing that the wounds had healed well and that a good aesthetic result was achieved. Liposarcoma of the spermatic cord is a rare disorder, and only approximately 100 cases have been reported worldwide [1]. Surgical management usually involves radical excision, and a large composite skin and soft tissue defect is created at or near Hesselbach's triangle, a naturally weakened area of the abdominal wall. A sizable dead space is also created after resection. Defects in the inguinal ligament, lacunar ligament, or conjoint tendon weaken the inferior or posterior border of the inguinal canal, further predisposing the patient to direct inguinal hernias if unrepaired. With these deficiencies in mind, our flap choice was based on the principle of replacing like with like. We required a moderately sized flap with a large reliable skin paddle to fill the dead space and resurface the 20×8-cm skin defect. Primary closure would have resulted in seroma formation in the dead space as well as tightness of the area of the groin crease on hip extension, which can lead to complications involving wound breakdown due to the high tension of the closure. Sufficient fascia should be present on the flap to repair the fascial defect at the inguinal region. Little information on postoperative complications has been published, but we believe that they would include poor wound healing due to excessive wound tension, development of a seroma, infections secondary to a large dead space, flexion contractures of the hip if skin grafts are used, and inguinal hernias due to the loss of the fascial integrity of the inguinal canal. Careful preoperative assessment of the composite defect and an understanding of the characteristics of each flap allowed us to narrow our flap options to a pedicled anterior-lateral thigh (ALT) flap or a pedicled ORAM flap. The ALT flap is often used to reconstruct defects in the head and neck, perineum, and lower limb, and involves a reliable blood supply that can be raised with a large skin paddle with minimal donor site morbidity. The ORAM flap is a myocutaneous flap based on the periumbilical perforators exiting the rectus abdominis muscle. Cadaveric studies have shown that when the periumbilical perforators were injected with dye, preferential filling was observed in a lateral and superio-lateral-oblique fashion [2]. Skin paddles of up to 43×8 cm in size are reported to have been safely raised [3]. A unique characteristic of the ORAM flap is the differential flap thickness of the skin paddle. It is thick near its origin at the periumbilical perforators, as it includes the full thickness layer of the rectus muscle, and becomes progressively thinner at the distal end. This was ideal for our reconstruction, as we required bulk in the proximal portion of the flap to obliterate the groin and inguinal dead space, while the thin and pliable distal end was used to reconstruct the thinner scrotal and perineal skin. The final results indicated that the soft tissue thickness was a good match to the surrounding skin. The length of the ORAM flap also allowed the tension-free resurfacing of the large longitudinal skin defect from the inguinal ring to the ipsilateral hemiscrotum. The excess skin paddle was de-epithelised and rolled up to fill the remaining area of the scrotal sac. We chose the ORAM flap over the ALT flap for three main reasons. First, a subcutaneous tunnel was created with an oblique projection into the right inguinal scrotal area. It is important to consider the posterior boundary of the subcutaneous tunnel. If this boundary is fixed, it forms a compression point on the vascular pedicle, increasing the risk of flap necrosis. The pliable transversalis fascia and the soft bowel loops form the posterior wall of the subcutaneous tunnel of the ORAM flap, while the relatively thick and inexpansile thigh muscles, femur, and iliac bone form the posterior wall of the tunnel of the pedicled ALT flap. The ALT flap undergoes greater compression in the subcutaneous tunnel than the ORAM flap. Second, by choosing the pedicled ORAM flap over the pedicled ALT flap, we were able to raise the ORAM flap simultaneously on the contralateral side while the sarcoma was being resected. This resulted in a shorter operative time, less blood loss, and a faster postoperative recovery. Finally, the arc of rotation of the ORAM flap was preferable to that of the ALT flap, which would have required a 'U-turn' to project the flap into the scrotum. It is critical to repair the fascial defect at and around the deep and superficial ring of the inguinal canal, as this fascia layer reduces the risk of future inguinal hernias. After measuring the fascial defect over the deep inguinal ring (5×3 cm), we harvested equal dimensions of the left anterior rectus sheath as part of the myocutaneous flap. This anterior rectus sheath was then used after tunneling the flap to close the fascial defect over the deep inguinal ring, replacing like with like. This avoided the use of a synthetic mesh, which would have carried a risk of implant infection as well as being more expensive. Instead of using a mesh to close inguinal fascial defects of this type, it would be more prudent to make use of the fascial component of the flap to reconstruct such defects. In conclusion, the contralateral pedicled ORAM flap is an attractive reconstructive option after the radical excision of a spermatic cord liposarcoma.

Human sparganosis is a rare zoonotic disease caused by the larval stages of Spirometra sp. A seven cm worm recovered from a painful swelling in the right inguinal region of a 9 year old boy from Kunnamkulam in Thrissur District, Kerala was identified as sparganum based on morphology. This is the first case report of the disease from Kerala state. Possible mode of infection and control measures are suggested. Increased public awareness about risks associated with drinking contaminated water is important to prevent further incidence in the locality.

We report a case of endometriosis of the round ligament in a 29-year-old woman, who complained of a lump with a diameter of about 2.5 cm in the right inguinal region, which increased in bulk and was accompanied by intense pain during the menstrual period. The clinical suspicion of inguinal endometriosis, supported by ultrasonography and Magnetic Resonance (MR), was confirmed by histological examination of the surgical specimen, which included the mass and the extraperitoneal segment of the round ligament. The authors conclude that the appearance of a lump in the inguinal region associated with subjective and objective changes of the lesion in relation to the menstrual cycle must raise the suspicion of endometriosis among the possible diagnoses.

We present the case of a 44-year-old man who presented with nausea, vomiting and acute pain in the right groin. On physical examination an irreducible mass was palpated in the right inguinal region. Ultrasound suggested an inguinal hernia sac with bowel contents. Subsequent right inguinal exploration revealed only unspecified necrotizing tissue, but no hernia sac or bowel contents were identified. Two days later laparotomy was required since the inguinal wound produced faecal discharge. The sigmoid appeared to be necrotic and perforated, and was subsequently resected. Histology revealed a perforated adenocarcinoma without lymph node involvement. Incarcerated inguinal hernias containing an adenocarcinoma of the colon are rare, but should be considered in patients presenting with an irreducible palpable mass in the inguinal region. Moreover, a carcinoma of the sigmoid may invade the right inguinal region. An intestinal perforation to skin-level in this population is even rarer and is associated with high morbidity and mortality rates.

We report a case of postirradiation sarcoma that arose in the right inguinal region 8 years after completion of external beam radiation therapy for a localized adenocarcinoma of the prostate. The patient was treated in 1995 with a “mixed-beams” technique (18 MV photons and 65 MeV fast neutrons). Eight years after the end of treatment, he presented with a radio-induced, high-grade spindle-cell sarcoma. Cytogenetic analysis was performed to confirm the diagnosis. Although the use of external beam radiation therapy for the treatment of prostate cancer has been common practice for decades, postirradiation sarcomas have been reported to be rare sequelae of irradiation and, to our knowledge, only a few of them were cytogenetically investigated.

We report on a 31-year-old Japanese female with an epidermoid cyst developed in the right inguinal region. The lesion was excised and drained by a surgeon. Since there was a local recurrence of the lesion within 2 months, the patient visited us, and the lesion was completely excised. Only the cells in the lowermost layer of the cyst wall showed dysplasia, which was characterized by irregular, and hyperchromatic nuclei with coarsely clumped nuclear chromatin pattern. However, solar elastosis was not observed, and spongiosis surrounding the atypical cells was present. In addition, melanophages were seen in the upper dermis. In conclusion, atypical keratinocytes in the lowermost portion of the cyst wall were deemed to be secondary to inflammation due to treatment by a surgeon rather than to development of both in situ and invasive squamous cell carcinomas in an epidermoid cyst.

A case of a 40-year-old female with meralgia paresthetica after malignant tumor resection in the right inguinal region is reported. Traditionally, meralgia paresthetica is treated with neurotransection or neurolysis. The therapeutic strategy using neurolysis, and the use of a deep inferior epigastric perforator adiposal flap wrapping as a prophylactic procedure against reentrapment is discussed.

Desmoplastic small round cell tumor (DSRCT) is an extremely rare malignancy mainly located in the abdominal and pelvic peritoneal cavity. A few published studies have reported the involvement of testicular/paratesticular region. The present study describes an unusual case of paratesticular DSRCT that was discovered incidentally during imaging of an obstructed inguinal hernia in an old-age patient. After radical orchiectomy, the patient was administered treatment consisting of a multidrug combination chemotherapy and adjuvant radiotherapy and remained disease free during the 24-month followup period, with only one attachment of local tumor recurrence in the right inguinal region.

Lymphogranuloma venereum (LGV) is an uncommon, contagious, sexually transmitted disease (STD). We report a case of a 17-year-old teenager who presented with a 2-month-old ulcerous vegetant lesion in the right inguinal region. The patient was diagnosed with LGV and received erythromycin treatment. Three months after treatment, he presented with a new ulcerous lesion, very similar to the previous one, in the right supraclavicular region. He was diagnosed with a diffuse large B-cell non-Hodgkin lymphoma. Both diseases are rare in Rio de Janeiro City, Brazil, and physicians should not neglect the possibility of STDs in such cases.

Rhabdomyosarcoma (RMS) is a highly aggressive, malignant tumor of skeletal muscle cell, associated with an early and a wide spread metastasis. Although a commonly occurring soft tissue sarcoma in the pediatric population, it is seldom encountered in adults. Outcome for adult RMS is poorly documented due to its rarity. We report a case of pleomorphic RMS (PRMS) in a 50 years male presenting with an intra-abdominal mass along with a swelling in the right inguinal region measuring 4 cm Χ 3 cm. Computed tomography revealed an ill-defined intra-abdominal mass arising from the peritoneum. Abdominal mass was resected along with the dissection of inguinal lymph node. Histopathological examination of these masses coupled with the immunohistochemistry, confirmed the diagnosis of PRMS metastasizing into inguinal lymph node. Despite of adjuvant radiotherapy and chemotherapy, the patient couldn't survive >3 months and died of widespread lung metastasis.

We reported an 86-year-old female who visited out department on Sept. 14, 1998. She was diagnosed with malignant lymphoma which developed in the right inguinal region. She was in good health except for her lymphoma. First, a biopsy was performed after a diagnosis of SCC because of a nonsymptomatic dome-shaped tumor with granulomatous tumor. Histopathology showed that the tumor nest consisted of a clearly delineated proliferation of atypical and pleomophic T cells with multinuclei. After the diagnosis of T cell lymphoma, a wide local excision was carried out on Dec. 8, 1998. However, pulmonary metastasis occurred six weeks after the excision, and she died 10 weeks later of dyspnea. [Skin Cancer (Japan) 2002; 17: 201-204]

An unusual case of endometriosis involving the right round ligament in a 40-year-old woman is presented. After giving birth to two children, she first noticed a tender mass in the right groin at the age of 36. It didn't change in size but pain appeared at the age of 38, disturbing her daily life. A poorly circumscribed elastic hard mass, measuring 3 cm in diameter, was palpable in her right inguinal region. Magnetic resonance imaging demonstrated a 2x3 cm mass in the right inguinal canal. At operation, a mass was found to be in continuity with the round ligament at the inguinal canal. Histological diagnosis was endometriosis. After operation, she was completely relieved of pain. It is important to include endometriosis in the differential diagnosis for painful inguinal masses in women of childbearing age.

A 23-year-old woman presented with a painless vulval swelling. On physical examination, a soft fluctuant sausage-shaped mass was found, measuring approximately 4 cm, extending from the right inguinal region to the labia majora. Ultrasound revealed a well-defined hypoechoic elongated mass, septated, extending from the superficial inguinal canal to labia majora. Sonographic findings were consistent with the diagnosis of a hydrocele of the canal of Nuck. Surgical exploration revealed an elongated cystic lesion with a total length of 13 cm, mucous component and internal septations. Histopathological examination of the surgical specimen confirmed the suspected diagnosis.

Background: The splenic torsion is a rare condition in dogs, especially when it is not associated with gastric dilatation and volvulus. Abdominal ultrasonography has been reported as an accurate diagnostic method in cases of splenic torsion suspicions. Splenomegaly, decreased echogenicity of the parenchyma of the spleen and hypoechoic appearance or “lace” are suggestive sonographic findings, although the definitive diagnosis is given through exploratory laparotomy. This study reports a case of splenic torsion followed by abdominal trauma and eventration in a dog, highlighting the importance of the ultrasound examination.Case: An adult dog without a defined breed pattern that weighed 8.6 kg was referred to the Veterinary Hospital of the Federal University of Lavras (Universidade Federal de Lavras - UFLA) with a history of trauma caused by having been run over by a car 24 h earlier. The animal exhibited right inguinal region swelling with hematoma and a loss of local muscular tension. An abdominal ultrasound indicated that the spleen was displaced to the right inguinal region and that a portion of the spleen was included in the animal’s abdominal eventration. The spleen possessed an irregular surface with increased dimensions and diffusely decreased echogenicity and multiple parallel echogenic lines (in the reticular aspect). Abrupt differences in the echogenic textures of the spleen were identified in certain images. Color Doppler assessments revealed no blood flow. Based on the aforementioned ultrasound findings, an exploratory laparotomy was indicated. The laparotomy confirmed the presence of right inguinal abdominal muscle rupture with dislocation, eventration, and splenic torsion.Discussion: Splenic torsion may be most frequently reported in cases involving large and giant male dogs because this condition is typically related to dilatation syndrome and gastric volvulus, which are more prevalent among large and giant male dogs than among other dogs. Although these etiological factors should be considered, in the case examined in this study, the patient most likely suffered from splenic torsion caused by abdominal trauma, which resulted in the rupture of the gastrosplenic and splenocolic ligaments and the splenic vessels and thereby created circumstances conducive to splenic eventration and torsion. The sonographic features of splenic torsion in dogs include marked splenomegaly, a hypoechoic or diffuse anechogenic pattern that indicates the presence of vascular congestion, and sinusoidal dilatation separated by small linear echoes that represent dilated vessels. In cases of splenic torsion, two-dimensional ultrasonographic images may reveal an enlarged spleen with a hypoechoic echotexture and a hyperechoic triangle between the veins and the splenic parenchyma continuous to the hyperechoic mesentery. The sonographic findings observed in the patient examined in this study were similar to the findings described in the published literature and consistent with the results reported by the other authors. Although extensive literature reports have described the sonographic aspects of splenic torsion in dogs, this disease remains uncommon. Moreover, no prior reports have described splenic torsion secondary to concurrent abdominal trauma, displacement, and eventration; thus, the case examined in this study is unprecedented, and the ultrasonographic aspects observed in this case should be considered.

The association of testicular torsion and cerebral palsy is a well-known fact. But the infrequent presentation to emergency room makes the clinician sceptical. Such a presentation often puzzles the residents regarding the diagnosis and the treatment. Here we present a case of an adolescent boy aged with cerebral palsy 13 years with incessant crying and not feeding well for last 3days. Right inguinal region showed a tender globular swelling with absence of testis in scrotum along with signs of septicaemia. The inguinal exploration was performed under general anaesthesia which revealed gangrenous right testis. Right orchidectomy and left orchidopexy was performed and the patient recovered well. This case is reported for its complexity due to lack of reliable history, delayed presentation and associated comorbidities posing challenges to the treating surgeons.

Heterotopic adrenal cortex is usually found in the kidney, retroperitoneum and spermatic cord. It is common among pediatric age group and rarely encountered in adults. Our case presented with swelling in the right inguinal region with on and off dragging pain. On clinical examination testis was absent in the right scotal sac which was confirmed with ultrasonogram. The clinical diagnosis was right side undescended testis. Orchidectomy was performed and on microscopic examination we incidentally found out an ectopic adrenal cortical rest in the rete testis with atropic changes in the testis. Though the ectopic adrenal tissue was indolent in our case, literature suggests that it can undergo transformations like hyperplasia, adenoma and carcinoma, leading to undesirable complications. We present this case for the rarity at this age and site, and for the awareness that it may cause complications if left untreated.

We report a case of mesothelial cyst protruding from the right femoral ring with suspected endometriosis in a 35-year-old woman, who complained of a lump with a diameter of 6 cm in the right inguinal region. Although she had the hormone therapy during the next 8 months for the diagnosis of extragenital endometriosis, her symptoms did not improve. The clinical suspicion of a Nuck cyst with endometriosis, supported by ultrasonography and magnetic resonance imaging, was confirmed by histopathological examination of the surgical specimen. Authors herein report this unusual case and review the literature.

Calcifying fibrous tumors are rarely seen and affect mostly children and young adults. A 21-year-old man presented with multiple palpable masses in the area from the right inguinal region to the anteromedial thigh. We performed a diagnostic excisional biopsy. Histopathologically, it was composed of fibroblasts, psammoma bodies, dystrophic calcifications and foci of mononuclear inflammatory cell infiltration in a collagenous dense stroma. We herein reported a case of calcifying fibrous tumor and discussed its clinical and morphological features with regard to the literature.

The patient was a 47-year-old male, who visited Hidaka Hospital with a chief complaint of swelling in the right inguinal region and the scrotum. With a diagnosis of a right spermatic cord tumor, right high orchiectomy was performed. Since an inflammatory type of malignant fibrous histiocytoma (MFH) was diagnosed from histopathological findings, chemotherapy and radiation therapy were performed as postoperative treatment. Malignant fibrous histiocytoma with the primary focus of the spermatic cords is a rare disease. To our knowledge, this is the 20th case of MFH of the spermatic cord in Japan (the 42nd in the world) and it is the second case of inflammatory type of MFH in Japan.

Fibrolipoma of the spermatic cord is extremely rare. A case of giant fibrolipoma of the right spermatic cord is reported here. A 68-year-old man noticed a mass in the right inguinal region, and was admitted to Shizuoka City Shimizu Hospital. Tumorectomy and right orchiectomy were performed. Grossly, the tumor was a well-defined, yellowish white, solid, firm tumor measuring 13 x 10 x 9 cm. The tumor had a thin capsule. The tumor was attached to the right spermatic cord, and was remote from the right testis and epididymis. Microscopically, the tumor was composed of mature adipose tissue (40% in area) and collagenous fibrous tissue (60% in area). No lipoblasts were recognized, and on immunohistochemistry the tumor was negative for MDM2 and CDK4. Neither smooth muscle nor vascular proliferation was recognized. The tumor was diagnosed as giant fibrolipoma of the right spermatic cord. To the best of the author's knowledge, only two cases of fibrolipoma in the spermatic cord, scrotum, and testis have been reported in the English-language literature.

Kimura's disease is a rare chronic inflammatory disease, which typically occurs in middle-aged Asian men. This benign lymphoproliferative disorder with tissue eosinophilia is clinically characterized by painless subcutaneous swelling or induration, affecting the head and neck region. Here we present a 42-year-old Japanese woman with a giant tumor on the right inguinal region. The tumor was diagnosed as Kimura's disease, because of massive infiltration of lymphoid follicle-forming lymphocytes and eosinophils with elevated serum immunoglobulin E and blood eosinophilia. She also had nephrotic syndrome histopathologically diagnosed as membranoproliferative glomerulonephritis (MPGN). Renal involvement is known as one of the associated conditions with Kimura's disease. The skin and renal diseases were successfully treated with corticosteroids and surgical removal of the mass.

A 31-year-old woman presented with a mass in her groin accompanied by intense pain during the menstrual period. A poorly circumscribed, elastic, hard mass was palpable in her right inguinal region. Magnetic resonance imaging showed that the mass had continuity with the inguinal course of the round ligament of the uterus. The mass lesion was well enhanced with high intensity on diffusion-weighted imaging. An operation was performed, and the histological diagnosis was endometriosis of the round ligament. After operation, she was completely relieved of pain. It is important to include endometriosis in the differential diagnosis in women with painful inguinal mass lesions at risk for endometriosis.

A 25-year-old male, who was a known case of oculocutaneous albinism presented to us with right inguinal swellings of six months′ duration. He gave a preceding history of a similar lump in the right thigh, which was excised at the Chennai Government Hospital. He was diagnosed to have oculocutaneous albinism with actinic keratoses, with multiple squamous cell carcinomas (with metastatic deposits in the right inguinal region) and cutaneous horns. The case is reported to highlight preventive aspects in the management of albinos.

An otherwise healthy 36-year-old woman consulted our department with abdominal wall pain. She had a history of double Cesarean section, and lumbar scoliosis. The pain was described as cramping and soar, intensifying after physical activity. The painful area was located cranially to the right superior pubic ramus, radiating towards the right inguinal region. Abdominal ultrasound revealed a heterogeneous mass located in the rectus abdominis muscle, in proximity of its insertion. Hyperechoic and hypoechoic nodules were present, accompanied by a mild degree of internal vascularization (Fig. A). The mass was well defined, and could be differentiated from the surrounding rectus abdominis muscle. Dimensions were approximately 2.27 × 1.23 × 3.41 centimetres (Figs. B, C). Due to the sonographic features and clinical history, the diagnosis of endometrioma of the rectus abdominis muscle was suggested. Histopathology after surgical excision confirmed this diagnosis later on.

A 21-day-old female infant is admitted to the neonatal unit with unilateral right groin swelling and fever. She was born by cesarean section at 36 weeks with a birth weight of 2,400 g. Antenatal and perinatal history was uneventful, and there was no history of maternal fever or premature rupture of membranes. After birth, the infant developed severe transient tachypnea of newborn with pulmonary arterial hypertension that required ventilation support and umbilical cannulation. During a hospital stay of 14 days, the infant received vitamin K, intravenous fluid therapy, inotropes, and antibiotics, the blood culture was sterile. The femoral triangle on either site was not used for phlebotomy. There was no history of omphalitis. After 1 week the infant is readmitted with fever and right groin and right thigh swelling. On evaluation the infant is febrile and toxic-appearing, with swelling in the right inguinal region that extends to the anteromedial aspect of the thigh, which is tender and associated with restricted movement at the hip joint. Diagnosis of possible septic arthritis is made. Laboratory evaluation …

Hernia uteri inguinalis in male hermaphroditism is rare and there have been only 54 other similar cases in Japan. We present a case of hernia uteri inguinalis in male hermaphroditism. A 52-year-old man was admitted to the hospital because of painful swelling involving the scrotal sac and right inguinal region. Abdominal CT scan and magnetic resonance imaging (MRI) revealed a tumor shadow and intestinal gas extending from the scrotal sac to right inguinal region. The preoperative diagnosis was incarceration of hernia inguinalis of the intestinal tract. Radical operation for hernia inguinalis was performed. Hernia sac contained the sigmoid colon and two ovary-like, two salpinx-like and uterus-like structures were found in the right inguinal canal. Histopathologically, the ovary-like structure was the testis and the uterus-like structure was the urerus. The chromosomes and hormonal examinations were normal.

We report one rare case of superficial angiomyxoma of the right inguinal region, in a 67-year-old man. The tumor, measuring 4.5 x 4.0 x 3.0 cm, had a finger-like shape, was composed of a well circumscribed conglomerate of multiple myxomatous nodules and was located partially in the dermis and partially in the subcutaneous tissue. Microscopically, in contrast to previously reported cases, the tumor was composed mainly of oval plump stromal cells with an amphophilic cytoplasm. Spindle-shaped stromal cells were scattered throughout the tumor. The tumor border was not infiltrative and was well defined by thick hyalized collagen bundles. Neither hyperchromasia nor pleomorphism was apparent. No mitotic figures were detected in the specimens prepared. Small to medium-sized blood vessels showed a scattered distribution, but large vessels, seen frequently in aggressive angiomyxoma, were absent. Moreover, no plexiform capillary pattern was evident. These findings were diagnostic of superficial angiomyxoma. Although this disease entity is considered as including cutaneous focal mucinosis, follicular fibroma, trichofolliculoma and trichogenic adnexal tumor, we propose that these tumors should be excluded.

A 70-year-old male was hospitalized for right scrotal mass without pain in October 1991. Right orchiectomy was performed under a diagnosis of right epididymal tumor. Histopathological diagnosis was testicular adenomatoid tumor. In June 1992, he was admitted with a mass in the right inguinal region and a tumor was resected. Histopathological diagnosis was malignant testicular mesothelioma. Therefore, retroperitoneal lymphadenectomy was performed as additional therapy. One year after surgery he showed signs of recurrence and was admitted for treatment and further examination. Computed tomography demonstrated right inguinal and femoral mass. Thus he underwent total penectomy and radical ilioinguinal lymphadenectomy under a diagnosis of metastatic and recurrent mesothelioma of the testis. Three months postoperatively he developed a recurrence in the skin and lung field. After combination chemotherapy, the metastatic skin lesion was in remission but the lung lesion did not respond. Metastatic lung tumor grew rapidly and the patient died. The incidence of malignant mesothelioma of the tunica vaginalis testis is rare and 48 cases have been reported in the literature.

A 76-year-old women was admitted to the hospital because of edema of the right lower leg and an anal canal mass. The mass on the right side of anal canal was 6.5×2.5cm in size and many hard lymph nodes in the right inguinal region were palpated. Angiography via the right internal iliac artery revealed a tumor stain in accordance with the anal canal mass. Then we inserted a catheter via the right internal iliac artery and administered CDDP and 5-FU. The mass and inguinal lymph nodes began to reduce about 11 weeks after the chemotherapy. The patient has been administered CDDP by intra-arterial infusion once a week and 5'-DFUR orally everday and she has been well now. We conclude that only the intra-arterial infusion chemoterapy is effective for the squamous cell carcinoma of the anal canal and keeps the quality of life in this patient.

Androgen Insensitivity Syndrome Diagnosed in an Elderly Patient during a Strangulated Inguinal Hernia Repair INTRODUCTION A strangulated inguinal hernia is a common indication for emergency surgery. In comparison, complete testicular feminization is a rare genetic disease that can present with an inguinal hernia because of ectopically positioned testicles. PRESENTATION OF CASE A 70-year-old female was admitted to the emergency service complaining of a painful swelling in the right inguinal region for 1 day. The physical examination indicated a strangulated inguinal hernia and surgery was performed. On exploring the inguinal region, a strangulated indirect inguinal hernia and hard 2 × 3-cm mass were detected. The histopathological examination of the excised mass showed testicular tissue, and complete testicular feminization (CTF) was diagnosed after further examinations. DISCUSSION Androgen insensitivity syndrome (AIS), the most frequent cause of male pseudohermaphroditism. The diagnosis of patients with AIS is usually made at the beginning of the second decade when a healthy person with a female phenotype complains of no menarche. Making a first diagnosis after the 5th decade is extremely rare. CONCLUSION While AIS can be diagnosed in early adulthood, cases might not bediagnosed until the patient is of advanced age.

Introduction Retro-rectal cystic hamartoma (tailgut cyst) is a rare congenital developmental lesion arising from post-natal primitive gut remnants in the retro-rectal space. The rarity of the lesion and its anatomical position usually leads to difficulty in diagnosis and surgical management. Complete surgical resection remains the cornerstone of treatment. A dozen or so surgical approaches have been described in the literature to date to make the operation as simple as possible, but the trans-rectal access route is extremely rarely reported and not well described. Here, we present a case that demonstrates the trans-rectal approach to a retro-rectal tumor is a feasible option in terms of surgical radicality, minimal invasiveness and safety for carefully selected patients with this rare type of retro-rectal cystic lesion. Case presentation A 29-year-old Caucasian woman was referred to our institution due to perineal pain extending to the right inguinal region. Her symptoms had been present for the last two months. She was first examined at her regional hospital for a suspected ruptured ovarian cyst; however, after consultation with a gynecologist and a computed tomography scan of her pelvis, a tumor in the retro-rectal space was discovered. Our patient was admitted to our hospital and when a pelvic magnetic resonance imaging study confirmed the diagnosis of the retro-rectal cystic formation, a complete extirpation of retro-rectal tumor fixed to the coccyx using trans-rectal approach was performed. The final pathological diagnosis was retro-rectal cystic hamartoma (tailgut cyst) with no evidence of malignancy. Her post-operative course was uneventful, and at four months after surgery our patient is symptom free with no evidence of recurrent or residual disease. Conclusions Trans-rectal excision is feasible in terms of surgical radicality and is a simple to perform, minimally invasive and safe option, providing complete recovery for carefully selected patients with retro-rectal cystic hamartoma treated operatively.

Ileo-ovarian knotting in a case of strangulated inguinal hernia, reported herein, has never been reported before. We believe this case is of great importance because of its absolute rarity. A 46-year-old female came with right inguinal swelling, vomiting, and abdominal distension for 2 years but aggravated during the last week. She had passed stools 24 h ago and was vomiting since then. The abdomen was distended as well as tenderness and guarding was noted in the lower abdomen. Examination revealed strangulated right inguinal hernia with abdominal X-ray suggestive of acute small bowel obstruction. Abdominal ultrasonography revealed dilated small bowel loops and aperistaltic edematous intestines in the right inguinal region; an urgent surgery was, hence, planned. Exploration revealed ileo-ovarian knotting with one-foot gangrene of small bowel and strangulated right ovary. Resection of the right ovary, bowel resection, and end-to-end anastomosis with hernioplasty were performed. The patient recovered well in the postoperative period.

A 3 days female newborn , born at term by Cesearean section, with a birth weight of 3200 g, was brought to the casualty with the complaints of irritability and a lump in her right groin by her mother. On physical examination, a non-fluctuant mass which was irreducible was palpated in the right inguinal region, just above the labium majora. JMS 2016; 19(1):35

Hydrocele of the canal of Nuck is a rare cause of inguinal swelling in females. We present the case of a 9-year-old girl, who underwent omphalocele repair shortly after birth. She presented with a painless swelling in the right inguinal region; it was of a hard elastic consistency and ultrasound image showed an oval lesion containing fluid, located in the subcutaneous soft tissue. Removal of the lesion and histological examination of the surgical specimen confirmed cyst of the canal of Nuck.L’idrocele del canale di Nuck è una rara causa di tumefazione inguinale nelle donne. Presentiamo il caso di una bambina di 9 anni, operata alla nascita per onfalocele, con una tumefazione nella regione inguinale destra non dolente, di consistenza duro-elastica, che all’ecografia appariva come una formazione ovalare a contenuto fluido localizzata nel contesto dei tessuti molli sottocutanei. L’asportazione della lesione e l’esame istologico hanno confermato la diagnosi di cisti del canale di Nuck.

This case describes the presentation and management of an 8 yr old phenotypically female intersex male dog presented for evaluation of a mass in the right inguinal region. The right inguinal space was surgically explored, and a large irregular mass resembling a fully developed testicle was identified in the right vaginal tunic. A second mass resembling an atrophied, but anatomically mature testicle, was identified in the left tunic. The larger mass was identified as a Sertoli cell tumor that had replaced all normal testicular tissue. The smaller mass was identified as a testicle that contained a small intratubular seminoma. The patient was diagnosed as having a phenotypic female sex, chromosomal male sex, and a gonadal male sex. Hormone assays completed before and after the gonadectomy and mass removal document an elevation of circulating progesterone presurgically that returned to baseline by 1 mo postsurgically. The source of the progesterone was identified to be the Leydig cells of the atrophied testicle.

This report describes a case of adult ileocolic intussusception of unknown origin that was preoperatively diagnosed. A 56-year-old man was admitted to the hospital because of a sudden onset of pain in the right inguinal region. Plain abdominal X-ray on admission showed multiple fluid levels and dilatated intestines. Abdominal ultrasono-graphy showed target like appearance. From these findings ileus due to intussusception was suspected and the patient was immediately operated on. The operative findings revealed ileocolic intussusception and a tumor of 2cm by 2cm at the ileum outside the intussusception. Then the ileac and colonic segments involved were resected. Histopathological findings for the tumor were consistent with these of submucosal lipoma. In case of adult intussusception some organic changes such as the presence of a tumor are often associated with the intussusception. In that case the leading point is mostly the organic change. But in our patient the lipoma at the ileum was not the leading point. From these observations, it was thought that the intussusception in this case was idiopathic. Preoperative diagnostic ultrasonography appears very useful as a diagnostic measure, because it is not invasive and easy to use.

A 70 year-old man was diagnosed with a nodular type malignant melanoma involving the lower back with satellite lesions (stage IIIB, T4b N2c M0, Breslow’s tumor thickness; 10.3 mm, Clark’s level; IV) (Fig. 1a). Sentinel lymph node evaluation was not performed. Three months after the excision of the primary melanoma with a 2-cm margin, skin metastasis appeared on his right inguinal region. Physical examination an additional month later revealed a firm, black-colored 5-mm sized nodule with crusts on the surface on the right thigh, with surrounding subcutaneous induration (Fig. 1b). Dermatoscopic examination found that keratins at the surface of the central lesion and a bluewhite veil at the periphery. Histological examination of a totally removed nodule showed a small, symmetric and well-circumscribed lesion composed of nests of numerous atypical melanocytes in the dermis (Fig. 1c). Those atypical cells were positively stained with Melan-A, HMB45 and S-100. Tumor cells were located in abutment with and also within the epidermis. Nests of atypical melanocytes were confined to the crusts and perforated the skin surface (Fig. 1d). Treatment with chemotherapy was not implemented because the patient refused aggressive treatments. Six months after the onset of skin metastasis, he died of respiratory failure.

Right Inguinal region pain is a common complaint evaluated in surgical department. The number of differential diagnoses is lowered when the pain in a male patient is associated with a palpable tender mass. These diagnoses include inguinal hernia, inflamed inguinal lymph node, rectus sheath hematoma, cryptorchidism, mass derived from the spermatic cord, and polyorchidism. Right Inguinal region mass and pain caused by a spermatocele are unusual. Here we report a case of extra scrotal spermatocele causing right Inguinal region swelling and pain. To our knowledge this is a second reported case.