Friday, August 16, 2013

INGUINAL HERNIA : OMENTOCELE

A 65 year old gentleman came with right hemiscrotal swelling and unrelenting pain.He didnot have any alteration of bowel or bladder symptoms.
He was a patient with thalassemia trait and asymptomatic for the same.
On examination there was irreducible complete inguinal hernia.He did not have any other obvious causes for the increased intra-abdominal pressure( prostatomegaly resulting in obstructive LUTS, cough,constipation etc).
We as a protocol evaluate all patients with hernia for prostatic symptoms and prostatomegaly( USG KUB and post void urine, uroflwometry and Serum PSA in more than 50 years of age).
He was taken up for open hernia repair.Inguinal incision was given.The sac was dissected.The omentum was incarcerated so we had to resort to omentectomy.The sac was excised and closed at deep inguinal ring by purse string suturing.Mesh plasty was carried out with Vipro mesh.

Inguinal hernia:
Hernia is abnormal protrusion of abdominal viscus from abnormal opening in the abdominal wall(  this is the way we were taught in MBBS  days).Inguinal hernia is bulge in the groin.It is classified into direct( through the posterior wall weakness in the inguinal canal ) or indirect ( through the deep inguinal ring lateral to the inferior epigastric artery).

The hernia contents can vary from the intestines, omentum,appendix or even the bladder.In initial stages the bulge can be very  small ; many of these herniae dont progress.So there is consensus that these hernia can be observed.( progression and strangulation chances 0.2% while post herniorrhapy pain 10-20%).

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