Challenging surgical management of a giant inguinoscrotal hernia: Report of a case

Vasiliadis, Konstantinos; Knaebel, Hanns-Peter; Nyarangi-Dix, J.; Schmidt, Jan; Büchler, Markus W.

doi:10.1007/s00595-009-4125-3

Cited by 35 publications

(43 citation statements)

References 15 publications

(26 reference statements)

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“…3,17 The already demanding surgical repair of these herniae is further complicated by comorbid conditions such as advanced age, obesity, and cardiac or respiratory diseases, which influence perioperative course 3,5 and have an impact on the initial surgical decision making and postoperative morbidity and mortality. 5 The duration of elective postoperative mechanical ventilation is crucial in the recovery of these patients. Ventilation for a minimum period of 10 days in the intensive care unit after replacement of contents and repair has been suggested.…”

Section: Discussionmentioning

confidence: 99%

“…3 Results of progressive pneumoperitoneum have been controversial. 5 The recommended method for progressive pneumoperitoneum is by injection of 100 to 500 mL air daily for approximately 15 days through an intraperitoneal catheter, 7,11 and it is contraindicated in patients with strangulated hernia, cardiac diseases, and infections. 18 Visceral resection is associated with potential morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

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Giant Inguinoscrotal Hernia—Report of a Rare Case With Literature Review

Karthikeyan

Sistla

Ram

et al. 2014

International Surgery

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Massive inguinoscrotal hernias extending below the midpoint of the inner thigh, in the standing position constitute giant inguinoscrotal hernias. We report a patient who presented with giant right inguinal hernia with bilateral hydrocele for 25 years. He had no cardiorespiratory illnesses. He was taken up for surgery under general anesthesia after preoperative respiratory exercises. Sliding hernia with entire greater omentum, small bowel, and appendix as contents was identified. Meshplasty after omentectomy with bilateral subtotal excision of sac, right orchidectomy, and scrotoplasty were done. Giant inguinoscrotal hernias pose significant problems while replacing bowel contents because of the increase in intraabdominal and intrathoracic pressures. Recurrence is another complication seen after successful surgical management. Various techniques such as preoperative pneumoperitoneum, debulking abdominal contents with extensive bowel resections, or omentectomy and phrenectomy have been tried. Postoperative elective ventilation is also needed in many cases. We describe simple reduction with omentectomy as a viable technique in this patient. He did not need elective ventilation due to preoperative respiratory exercises and preparation and review of the literature.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Giant Inguinoscrotal Hernia—Report of a Rare Case With Literature Review

Karthikeyan

Sistla

Ram

et al. 2014

International Surgery

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“…These specific problems have considerable psychological impact. These patients have serious co-morbid conditions that have an impact on both initial surgical decision-making and post-operative morbidity [5].…”

Section: Discussionmentioning

confidence: 99%

A rare case of direct inguinal hernia presented as a huge scrotal hernia in a patient with aspergillus lung disease

T¹,

.K²

2014

IOSRJDMS

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“…Complications of these hernias in addition to the complications common to all hernias i.e., incarceration, obstruction and strangulation also include visceroptosis, reduction in mobility, intertrigo leading to ulceration of the scrotal skin, voiding difficulties, stretching of the spermatic cord which can lead to testicular atrophy and necrosis [3]. The combination of these complications has been shown to lead to psychological sequelae and social isolation [4].…”

Section: Discussionmentioning

confidence: 99%

“…Tensor fascia lata musculocutaneous flaps and scrotal skin flaps are the most well described [2]. Alternatively, debulking of the hernia contents via limited resection prior to reduction into abdominal cavity has also been reported with some success [4]. In the emergent setting, principles of management include preoperative resuscitation, radical debridement of necrotic tissue, minimizing length of surgery and leaving wounds open with a view to performing staged procedures at a later date [6].…”

Section: Discussionmentioning

confidence: 99%

Giant inguinoscrotal hernia: An emergency presentation with life-threatening sepsis

Burke¹,

Joyce²,

Ahmed³

et al. 2014

IJCRI

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A 74-year-old male was brought by ambulance to the emergency department with a 12-hour history of an acutely painful scrotum with associated rapidly progressing discoloration of the overlying scrotal skin. This was on a background of a giant inguinoscrotal hernia present for approximately 12 years for which he had previously declined operative intervention. Other than well controlled hypertension, his past medical was unremarkable. Upon arrival in the emergency department, he was noted as being markedly hypotensive and displaying clinical signs consistent with septic shock. His scrotum was noted as being grossly enlarged with a black discoloration (Figure 1). Several fluids filled bullae were noted on the scrotal skin ( Figure 2). On physical examination his abdomen was soft and non-tender. Initial resuscitation was provided in accordance with ATLS and sepsis guidelines. Anesthetic input was sought and the patient was transferred to the intensive care unit for continued resuscitation in the form of central venous pressure monitoring and inotropic support prior to emergency operative intervention. The patient's condition was deemed too unstable for transfer to the radiology department for preoperative imaging.In theatre, initial incision of the scrotum and examination of the scrotal contents revealed necrotic loops of small and large bowel. Mesenteric thickening was noted at the neck of the hernia sac. In light of this, a midline laparotomy incision was made and the necrotic hernial contents were reduced into the abdominal cavity

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Challenging surgical management of a giant inguinoscrotal hernia: Report of a case

Cited by 35 publications

References 15 publications

Giant Inguinoscrotal Hernia—Report of a Rare Case With Literature Review

Giant Inguinoscrotal Hernia—Report of a Rare Case With Literature Review

A rare case of direct inguinal hernia presented as a huge scrotal hernia in a patient with aspergillus lung disease

Giant inguinoscrotal hernia: An emergency presentation with life-threatening sepsis

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