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Background Emergency appendectomy is often performed for de Garengeot hernia. However, in some cases, there may be a chance to perform an appendix-preserving elective surgery. Case description A 76-year-old woman presented to our hospital with complaints of a right inguinal swelling, which we diagnosed as a de Garengeot hernia using computed tomography (CT). B-mode ultrasonography (US) of the mass showed an appendix 4–6 mm in diameter with a clear wall structure; color Doppler US showed pulsatile blood flow signal in the appendiceal wall. Twenty-eight days later, herniorrhaphy with transabdominal preperitoneal repair (TAPP) was performed without appendectomy. Another 70-year-old woman presented to our hospital with complaints of a painful bulge in the right inguinal region. The diagnosis of de Garengeot hernia was made using CT. B-mode US showed an appendix 5 mm in diameter with a clear wall structure. Color Doppler US showed a pulsatile blood signal in the appendiceal wall. Seven days later, herniorrhaphy with TAPP was performed without appendectomy. Conclusion De Garengeot hernia is often associated with appendicitis; however, an appendix-preserving elective herniorrhaphy can be performed if US and intraoperative findings do not suggest appendicitis or circulatory compromise in the appendix.

Context: Inguinal skin is prone to various infectious dermatological conditions such as erythrasma, intertrigo, hidradenitis suppurativa, folliculitis, dermatophytic infection, and various sexually transmitted diseases, as compared to the skin elsewhere. Aim: Our study attempts to compare the biophysical profile parameters (BPPs) of the genital skin with that of the rest of the body, while taking skin of the upper back as control. It also attempts to find out if there is a difference in BPPs of the two sites and that how the change in the BPPs, bring about change in microbiome and make inguinal skin more prone to infections. Materials and Methods: This was a hospital-based comparative study conducted over 976 patients (600 males and 376 females) of age group 18–60 years, where BPP parameters such as hydration, skin pH, transepidermal water loss (TEWL), and sebum content were measured over the skin of the upper back and right inguinal region, and the results were summarized and presented as proportions (%). Chi-square test was used to compare abnormal findings. P ≤ 0.05 was taken as statistically significant. MedCalc 16.4 version software was used for all statistical calculations. Results: Significant difference was noted in skin pH and TEWL, where P value came out to be

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

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

Background Inguinal hernia repair is one of the most common general surgical operations worldwide. We present a case of indirect inguinal hernia containing an expanded portosystemic shunt vessel. Case summary We report a 72-year-old man who had a 4 cm × 4 cm swelling in the right inguinal region, which disappeared with light manual pressure. Abdominal-pelvic computed tomography (CT) revealed a right inguinal hernia containing an expanded portosystemic shunt vessel, which had been noted for 7 years due to liver cirrhosis. We performed Lichtenstein's herniorrhaphy and identified the hernia sac as being indirect and the shunt vessel existing in the extraperitoneal cavity through the internal inguinal ring. Then, we found two short branches between the expanded shunt vessel and testicular vein in the middle part of the inguinal canal and cut these branches to allow the shunt vessel to return to the extraperitoneal cavity of the abdomen. The hernia sac was returned as well. We encountered no intraoperative complications. After discharge, groin seroma requiring puncture at the outpatient clinic was observed. Conclusion If an inguinal hernia patient has portal hypertension, ultrasound should be used to determine the contents of the hernia. When atypical vessels are visualized, they may be shunt vessels and additional CT is recommended to ensure the selection of an adequate approach for safe hernia repair.

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

Introduction: Persistent Müllerian duct syndrome (PMDS) is a rare form of internal male pseudohermaphroditism characterized by the presence of rudimentary Müllerian structures in a virilized male often presenting as undescended testes. Thus, each patient diagnosed with undescended testes should promptly be investigated for PMDS because the early diagnosis has direct effects on outcome and prognosis. Case report: A 26-year-old-male complained of long-standing abdominal pain two years ago and was diagnosed having bilateral undescended testes in the pelvic region. He underwent the orchidopexy about one year ago but, after 5 months of orchidopexy, he first complained of discomfort in the left and then right inguinal region due to an incisional hernia that presumed to have the ovotesticular disorder of sexual development. On the pelvic MRI exam, the Müllerian duct structures were observed and he was diagnosed as having PMDS. Discussion: In this case the patient had bilateral cryptorchidism with testes fixed in the para iliac region with respect to the uterus, indicating the female type of PMDS which is a rare type of PMDS. The case is proven genetically and Müllerian duct remnants have been resected to avoid malignant transformation. Conclusion: Persistent Mullerian duct syndrome (PMDS) is a rare finding and may present as long-standing abdominal pain. Each patient diagnosed with undescended testes should promptly be investigated for PMDS. Diagnosis and management aim to preserve fertility and prevent malignant changes. Therefore, familiarity with this rare condition will lead to adequate management and prevention of complications. © 2020, Not applicable.

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

Traumatic testicular dislocation is a rare complication secondary to different kinds of accidents. A 61-year-old man, who was injured by wall collapse and was diagnosed as pelvic fracture and posterior urethral rupture 5 months ago, came to the urologic department to seek urethral reconstruction. However, thorough physical examination and imaging examination confirmed a round mass in the right inguinal region and an empty right scrotum, which support diagnosis of testicular dislocation. The patient did not take the initiative to complain about that because he thought the right testis had been destroyed by the accident already. So the patient underwent fiber cystourethroscopy, urethral reconstruction, and orchiopexy. No testicular atrophy was confirmed at follow-up. We reviewed previous reports about traumatic testicular dislocation and analyzed the cause of delayed diagnosis.

Background Desmoid-type fibromatosis is a rare disease that can result in hydronephrosis. Hydronephrosis associated with desmoid-type fibromatosis often requires surgery or ureteral stent insertion. Although radiation therapy is recommended for inoperable cases of desmoid-type fibromatosis, there has been no report of treatment for hydronephrosis associated with desmoid-type fibromatosis by radiation therapy alone. We herein report a case of successful treatment for inoperable recurrence of desmoid-type fibromatosis with unilateral hydronephrosis by radiation therapy alone. Case presentation A 43-year-old Japanese female underwent resection of desmoid-type fibromatosis in the right inguinal region and combined resection of the right external iliac vein 5 years before. Other treatment was not performed because of her pregnancy. Four years after surgery, desmoid-type fibromatosis recurred in the right pelvic wall. Cyclooxygenase-2 selective inhibitor treatment was given for 1 year, but her desmoid-type fibromatosis enlarged to more than 10 cm, and she had swelling of her right leg and hydronephrosis of her right kidney. The patient received 50.4 Gy in 28 fractions of prophylactic irradiation using 10 MV X-ray and 9 Gy in five fractions of a sequential boost for the recurrent desmoid-type fibromatosis. Although there was temporary tumor progression at 1 month after radiation therapy, slow regression of the tumor was seen. At 5 years after radiation therapy, there was no disease progression or severe complications. Conclusion We experienced successful treatment for an inoperable case of desmoid-type fibromatosis with hydronephrosis. Moderate-dose radiation therapy alone is an effective and feasible approach for the management of hydronephrosis associated with desmoid-type fibromatosis.

A 40-year-old man with old neglected, non-union, pelvic ring injury right side was surgically treated with open reduction and internal fixation. In the immediate postoperative day, the patient had a large blister adjacent to the surgical site at the right inguinal region which complicated with eschar formation, and later split skin grafting was done. Accidental burns in operation theatre are very unusual. Burns due to electro-cautery and use of alcohol-based antiseptics are well documented in the literature. Iatrogenic burns due to prolonged operating light exposure are very rare and can cause severe damage in sensitive areas like the inguinal region.

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

Introduction Polyorchidism is a rare condition with a total number of approximately 190 cases. Malignancy was found in 6,4% of cases. Case presentation A 57 years old man came with a sudden and persistent painful mass in right inguinal region. The patient decided to undergo surgery with diagnosis of incarserated lateral hernia inguinal and obtained a testicular-like lump in the right inguinal canal, then the patient underwent orchiectomy. Histopathological examination revealed a soft tissue tumor with microscopic characteristic of seminoma. CT-Scan revealed metastasis to lung and liver. Conclusion Attention must be given to detect malignancy in polyorchidism., Highlights • Malignancy found in less than 1% of SNT. • Seminoma is the most common malignancy found in SNT. • Early detection of malignancy is recommended in patient with SNT.

Highlights • Epithelioid sarcomas (ESs) are rare and aggressive malignancy of a poor prognosis. • Radiotherapy may be an alternative treatment to decrease the size of the lesion. • Targeted therapy with pazopanib may be a treatment option for soft tissue sarcomas., Epithelioid sarcomas (ESs) of the vulva are extremely rare soft tissue tumors characterized by an aggressive clinical course and a poor prognosis. The proximal type of ES occurs in the trunk and external genital area and has higher recurrence and distant metastasis rates than the distal type, which is found in the upper and lower extremities. We describe a case of a vulvar ES in a 24-year-old patient who was referred from the department of plastic surgery with protruding mushroom-like lesions in multiple areas, including the lower abdomen, whole vulva, anus, and both inguinal lesions. A biopsy of the lesions confirmed a proximal-type ES. Computed tomography and magnetic resonance imaging revealed multiple metastatic lesions in several regions, including the perineum, vagina, and inguinal regions; nodal metastases in the left external iliac and right inguinal region; and distant metastases in the lungs, pleura of the left lung, bones, and soft tissue. The patient underwent active palliative radiotherapy, followed by chemotherapy, and showed a partial response to treatment. Nineteen months after the initial diagnosis, the patient expired due to cancer progression and pneumothorax.

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

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

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

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

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

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

Background The hydrocele of the femoral hernia sac, an extremely rare occurrence, is termed femorocele. Very few authentically reported cases of femorocele are available in the literature. The present case, diagnosed as a case of infected femorocele, was managed successfully by excision of the femorocele sac and repair of the femoral hernia. To the best of the author’s knowledge, it is the first-ever reported case of infected femorocele. Case presentation A 30-year-old lady presented with a painful 3 cm × 2 cm swelling in the right inguinal region. Though the swelling was there for 2 years, the pain and indurations started after a trivial blunt trauma over the swelling 7 days ago. The patient was febrile and mild tachycardic but had no dysuria. The oval-shaped, tense-cystic, poorly translucent, non-pulsatile, non-reducible swelling showed no cough impulse. There was also a (1.5 cm × 0.5 cm) palpable right-sided superficial inguinal lymph node. Routine blood and urine analysis reports were normal except leukocytosis (10,000/mm3) with neutrophilia. Ultrasonography of the right inguino-labial region revealed a mildly echogenic cystic swelling without any intra-abdominal communication. Exploration of the right inguinal region revealed a cystic (3 cm × 2 cm) swelling, medial to the femoral vessels, containing amber-colored fluid. The distal sac was excised, and anatomical repair of femoral canal defect was done after transfixing the neck of the femorocele sac. Fibro-fatty-collagenous tissue with mixed inflammatory cells along with a flattened mesothelial lining cell layer was found on histopathological examination. Sections from inguinal lymph node showed reactive hyperplasia. Culture of fluid from the sac revealed growth of Escherichia coli. The patient was put on anti-inflammatory drugs and antibiotics according to a sensitivity test. Patient was discharged in stable condition after 5 days. Four months after the operation, the patient is doing well, remaining asymptomatic and without any sign of recurrence. Conclusions The hydrocele of the femoral hernia sac is an extremely rare disease. When not infected, it presents a painless inguinal soft cystic swelling, commonly in women of fourth to sixth decade. This was diagnosed intraoperatively in all cases reported till date. Excision of the sac after transfixation of the neck and anatomical repair are the treatment of choice. In elderly patients, with larger defect, the mesh repair can be opted for. The femorocele may also get infected by uropathogens, and proper antibiotics should be used after a sensitivity test.

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

Research Areas: Veterinary Sciences Clinical, pathological, and immunohistochemical findings related to a feline mammary tumor with similar features to canine anaplastic mammary carcinoma are herein described for the first time. A female cat was presented for clinical evaluation with gastrointestinal signs, oedema, erythema, and painful lesion in the right inguinal region. Three weeks later, the mass had doubled in size and radiographic revaluation of the thoracic cavity revealed a metastatic pattern. Due to the poor prognosis and decline of the clinical status the owners decided for euthanasia. Post-mortem examination exposed a mammary tumoral mass with subcutaneous oedema, an enlargement of the right inguinal lymph node, and nodules in several organs. Histological analysis confirmed the presence of large pleomorphic epithelial cells, often grouped in small clusters with bizarre nuclei. Immunohistochemical study of the different lesions was performed and both primary tumor and regional metastasis showed tumor cells to be negative estrogen receptor alpha, positive progesterone receptor, positive HER-2, and positive pan-cytokeratin. Given that the clinical history was compatible with an inflammatory mammary carcinoma, the cyclooxygenase-2 expression levels were evaluated and presented a weak immunoreactivity. Regarding the distant metastatic lesions, tumor cells were negative for ER-α and PR and, positive both for HER-2 and pan-cytokeratin. info:eu-repo/semantics/publishedVersion

De Garengeot hernia is a rare femoral hernia defined as the presence of the appendix within the femoral hernia sac. The incidence of appendicitis in this type of hernia is a rare condition that accounts for 0.08–0.13% of all De Garengeot hernias. We describe the case of a 61-year-old woman that presented at the emergency department with a tender mass (diameter 10 × 8 cm) in the right groin region for 5 days associated with pain in lower right abdomen and accompanied by fever (38 °C). Computed tomography (CT) of the abdomen revealed the presence of a complex fluid collection with small foci of air in the right inguinal region, measuring 9 × 7 × 10 cm in the 3 orthogonal dimensions and a blind ending tubular structure extending from the caecal base into the groin mass through a narrowed neck defect, medial to the common femoral vessels. The CT scan demonstrated the suspected diagnosis of De Garengeot hernia complicated by acute appendicitis. The intra-operative findings confirmed the diagnosis. The patient was successfully managed operatively. The surgical strategy took into account the need to significantly reduce the diffusion of the infection inside the abdominal cavity. The patient was discharged on the fifth postoperative day without peri-/postoperative complications.

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

Adenomyomas are benign tumours made of smooth muscle cells, endometrial glands and stroma. An extrauterine location is extremely rare with an unknown pathogenesis. Preoperative diagnosis is challenging and pathologic examination is necessary to confirm the diagnosis. Here we present a case report of a 44-year-old woman with a painful non-reducible mass in the right inguinal region without fever or other alarming symptoms 2 months after a laparoscopic hysterectomy. She was treated with a surgical resection of the mass. Extrauterine adenomyoma is a very uncommon entity. Preoperative workup is challenging, as confirmation of the diagnosis can only be achieved by histopathological analysis following surgical excision.

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

Traumatic dislocation of testis is a rare event. We report a case of traumatic testicular dislocation in a 27-year-old patient presenting a right inguinal lump in a context of acute alcohol abuse with transient global amnesia. There was a tender mass in the right inguinal region and right hemiscrotum. He ascertained a previous scrotal position of both testes. The Doppler ultrasound confirmed the diagnosis of a dislocated right testis in right inguinal canal and surgical reduction and orchidopexy was performed. It is necessary to perform a complete physical examination in a trauma patient, early detection and management are both essential to preserve normal spermatogenic function.

A 45 year old male patient, was admitted to the emergency department of our hospital with acute pain over the right inguinal region. Physical examination founded an irreductibale and painful right inguinal hernia. The patient has been put in condition and he was brought to the operating theatre for emergency surgery. Surgical exploration by kelotomy revelated the presence of acute appendicitis (A) in a hernia sac corresponding to Amyand´s hernia (B). An appendectomy was preformed, and the hernia defected was closed by the technique of Bassinet. The patient recovered well and left the hospital two days after. The histological examination of the appendix confirmed the diagnosis of acute appendicitis.

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

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

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

Harvesting grafts from the anterior iliac bone has been associated with various complications. A 50-year-old woman presented to our department with a chief complaint of right inguinal swelling and pain. Autologous bone grafts had been harvested on two previous occasions from the right anterior iliac crest for use in the reconstruction of multiple facial fractures. Computed tomography and magnetic resonance imaging revealed a full-thickness bone defect in the right anterior iliac crest. A mass was noted in the right gluteus minimus, while a multilocular cystic mass extended from the right iliac crest defect to the right inguinal region. Both the inguinal mass and gluteal mass were removed under general anesthesia. Following histopathological analysis, the gluteal mass was diagnosed as a venous malformation(VM). Based on the patient’s clinical course, iliac bone graft harvesting and trauma to the gluteal region triggered hemorrhaging from the VM. Blood components leaked out from the fragile portion of the iliac bone defect, forming a cystic lesion that developed into the inguinal mass. In this case, a coincidental VM resulted in a rare complication of iliac bone graft harvesting. These sequelae could have been avoided by planning for more appropriate ways to collect the grafts.

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

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

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

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

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

Background Hepatocellular Carcinoma (HCC) is the most common primary carcinoma of the liver, which mainly metastasizes through the portal vein system. Case presentation Here, we report an extremely rare case in which HCC metastasized to the capsule of an undescended testis in the right inguinal area of the patient. A tumor approximately 8.8 × 7.0 cm in size was found in the patient’s liver during a health check-up. Initially, it was considered a metastatic tumor because the patient was found to have cryptorchidism, which had been left untreated before he presented to our hospital. The patient underwent a radical orchiectomy via inguinal approach, and the resected testis in the right inguinal region was examined via microscopy. The cancer cells were arranged in nests and showed abundant red or clear cytoplasm and marked nuclear atypia. Immunohistochemical staining showed that the tumor cells were positive for CK, CK8/18, AFP, hepatocyte, GCP3, but negative for PLAP, CD10, CD30, CD34, and vimentin. Conclusion According to these findings, the tumor in the inguinal region was considered a metastatic HCC arising from the liver, rather than a seminoma that had originated in the undescended testis. We suggest that during the diagnosis of malignancies, metastatic tumors should always be considered in the differential diagnosis even if the original presentation is at rare metastatic sites or concurrent with other disease(s).

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

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

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

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

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

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

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

An 83-year-old Caucasian male presented with a pruritic erythematous patch to his right inguinal region, which he had contracted five months ago. After months of topical antifungal and steroid therapies, the patient was referred to dermatology due to a lack of lesion improvement. A 5.0 mm punch biopsy with immunohistochemical staining revealed the presence of pleomorphic nuclei with cytoplasm replete with mucin, suggestive of superficial extramammary Paget's disease (EMPD). As he was reluctant to undergo a surgical assessment, the patient underwent consultation and management with 30 sessions of superficial electron beam radiotherapy. A week after the completion of radiation therapy, the patient's skin exhibited minimal erythema with surrounding hyperpigmentation to the affected inguinal skin, suggesting clearance of the disease. This case highlights the importance of an accurate diagnosis in a timely manner as neoplastic cases have a metastatic risk with potentially devastating results.