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    Pharmaceutical Sciences: Massive Inguinal Hernia-A Rare Presentation of Common Disease

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    This case report describes a massive inguinal hernia in a 60-year-old man. Ultrasound revealed that the man's entire intestines had herniated into his scrotum, forming a massive 50-60cm hernia. He underwent surgery where 3 liters of pus was drained, 16cm of intestine was resected, and a mesh was placed. Inguinal hernias are common but can lead to complications if left untreated, becoming large like this case. Surgical repair is the standard treatment option.

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    Pharmaceutical Sciences: Massive Inguinal Hernia-A Rare Presentation of Common Disease

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    iajps
    26 views4 pages
    This case report describes a massive inguinal hernia in a 60-year-old man. Ultrasound revealed that the man's entire intestines had herniated into his scrotum, forming a massive 50-60cm hernia. He underwent surgery where 3 liters of pus was drained, 16cm of intestine was resected, and a mesh was placed. Inguinal hernias are common but can lead to complications if left untreated, becoming large like this case. Surgical repair is the standard treatment option.

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    29.IAJPS29102020

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    This case report describes a massive inguinal hernia in a 60-year-old man. Ultrasound revealed that the man's entire intestines had herniated into his scrotum, forming a massive 50-60cm hernia. He underwent surgery where 3 liters of pus was drained, 16cm of intestine was resected, and a mesh was placed. Inguinal hernias are common but can lead to complications if left untreated, becoming large like this case. Surgical repair is the standard treatment option.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    26 views4 pages

    Pharmaceutical Sciences: Massive Inguinal Hernia-A Rare Presentation of Common Disease

    Uploaded by

    iajps
    This case report describes a massive inguinal hernia in a 60-year-old man. Ultrasound revealed that the man's entire intestines had herniated into his scrotum, forming a massive 50-60cm hernia. He underwent surgery where 3 liters of pus was drained, 16cm of intestine was resected, and a mesh was placed. Inguinal hernias are common but can lead to complications if left untreated, becoming large like this case. Surgical repair is the standard treatment option.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 4

    IAJPS 2020, 07 (10), 138-141 Rabia Ramzan et al ISSN 2349-7750

    CODEN [USA]: IAJPBB ISSN : 2349-7750

    INDO AMERICAN JOURNAL OF


    PHARMACEUTICAL SCIENCES
    SJIF Impact Factor: 7.187
    http://doi.org/10.5281/zenodo.4071272

    Available online at: http://www.iajps.com A Case Report

    MASSIVE INGUINAL HERNIA- A RARE PRESENTATION OF


    COMMON DISEASE
    Dr. Rabia Ramzan1, Dr. Raazia Ramzan2, Dr. Uzair Munaf 3
    1
    PNS-Shifa Hospital
    2
    Bahria University Medical and Dental College
    3
    Dow University of Health Sciences
    Article Received: August 2020 Accepted: September 2020 Published: October 2020
    Abstract:
    An inguinoscrotal hernia refers to a condition in which the fat or intestinal tissue push through the abdominal
    weakness of inguinal canal of either side. [1] We reported a case of 60-year-old man with right scrotal swelling
    reaching to the level of knees. Ultrasound abdomen confirmed the presence of all intestines in the scrotum.
    Corresponding author:
    Dr. Rabia Ramzan, QR code
    PNS-Shifa Hospital
    .

    Please cite this article in press Rabia Ramzan et al, Massive Inguinal Hernia- A Rare Presentation Of Common Disease., Indo
    Am. J. P. Sci, 2020; 07(10).

    www.iajps.com Page 138


    IAJPS 2020, 07 (10), 138-141 Rabia Ramzan et al ISSN 2349-7750

    INTRODUCTION: • Indirect inguinal hernia (80%) occurs via


    Inguinal hernia present as a swelling on the affected deep inguinal ring due to incomplete closure
    side of pubic bone with or without pain in groin with of processes vaginalis as seen in young
    associated increment in the swelling upon coughing individuals. [4]
    or weight bearing. Sometimes it is reducible by lying
    or with hand other times it’s irreducible. [2] This CASE REPORT:
    condition occurs oftenly in males than in females 60-year-old male non-smoker, with no known co-
    with a mortality rate of 27% in men and 3% in morbids admitted via OPD with complains of gradual
    women. [3] painful swelling of scrotum for last 6-7 years not
    associated with fever, vomiting or weight loss.
    According to Royal College of Surgeons it is Scrotum was reaching to the knees and swelling
    classified as: could be reduced to a little extent only.
    • Direct inguinal hernia (20%) occurs via
    superficial inguinal ring due to abdominal
    wall laxity as seen in elder individuals.

    On abdominal examination, no gut loops were present in abdomen and no bowel sound was heard on auscultation of
    abdomen. Ultrasound abdomen and pelvis was done which revealed massive 50-60cm right inguino-scrotal hernia
    with massive right hydrocele and herniated bowel loops in hernia. Patient was operated on 25/10/2018.
    Intraoperatively, 3litres of pus was drained and gut loops were reduced back in the abdomen with 16cm gut
    resection, and 15 x 15 cm mesh was placed to close the inguinal weakness. The resected gut was sent for
    histopathology and pus sample was sent for culture and sensitivity.

    Postoperatively patient was advised chest x-ray and blood CP, and was kept Nil per Oral for 72 hours. Blood CP
    showed Hb. of 6mg/dl so 3 unit of RCC were transfused after cross-matching.

    www.iajps.com Page 139


    IAJPS 2020, 07 (10), 138-141 Rabia Ramzan et al ISSN 2349-7750

    DISCUSSION: • Coated polypropylene


    Inguinal canal is the route by which spermatic cord in ii. Partially absorbable
    males whereas round ligament of uterus in females • Polypropylene + polyglactine
    pass through to support the respective reproductive • Polypropylene + polyglecaprone
    organs. Spermatic cord has 3 contents that are o Biological mesh [11-13]
    spermatic duct, blood vessels and nerve. [5]
    Following are the risk factors for developing inguinal Antibiotic prophylaxis is compulsory for any of the
    hernia: obesity, weight lifting, coughing which may afore-mentioned procedures and there is an evidence
    be due to any cause like COPD, straining with of better outcomes with single intravenous dose of
    urination and defecation, ascites, peritoneal dialysis 1.5g ampicillin and sulbactum in combination. [14]
    and ventriculo-peritoneal shunt. In prolong cases, [15]
    inguinal hernia may give rise to complications:
    ▪ Incarcerated hernia where the hernia is CONCLUSION:
    irreducible. Inguinal hernia is a common disease and needs to be
    ▪ Strangulated hernia which happens to be a treated early. If left untreated it may give rise to
    further complication of incarceration as the complications and even if there is no evidence of
    irreducible hernia starts to become ischemic as incarceration or strangulation it may gradually
    a result of compromised blood supply.[6] become massive enough to warrant emergency
    attention and may require intestinal resection.
    For the diagnosis of inguinal hernia, Ultrasonography
    and CT scan imaging are commonly used but are not REFERENCES:
    considered definitive diagnostic procedures. MRI is 1.http://www.healthline.com
    the definitive diagnostic tool for inguinal hernia. 2. http://www.mayoclinic.org/diseases-
    [7][8] conditions/inguinal-hernia/symptoms-
    causes/syc-20351547
    Treatment option for all inguinal hernias is surgical. 3. http://www.general.surgery.ucsf.edu/conditions--
    There are different surgical techniques which can be procedures/inguinal-hernia.aspx
    used: 4. http://www.teachmesurgery.com/general/small-
    ❖ Tension free prosthetic/mesh repair bowel/inguinal-hernia/
    o Anterior repair 5. www.niddk.nih.gov/health-information/digestive-
    1. Lichtenstein repair and its modifications diseases/inguinal-hernia
    2. Plug repairs 6. http://www.general.surgery.ucsf.edu
    3. Patch and plug repairs
    7. JAMA Surg.:1-4. doi:10.1001/jamasurg.2014.484.
    4. Double layer devices
    8. Robinson A, Light D, Nice C. Meta-analysis of
    o Posterior (pre-peritoneal) repairs
    sonography in the diagnosis of inguinal hernias.
    1. Open techniques via inguinal incision
    J Ultrasound Med2013; 32: 339–46
    2. Stoppa repair
    9. Hippokratia. 2011 Jul-Sep; 15(3): 223–231
    3. Laparoscopic/endoscopic repairs
    10. Alvarez Pérez JA, Baldonedo RF, Bear IG, Solís
    a. Trans-abdominal pre-peritoneal
    JA, Alvarez P, Jorge JI. Emergency hernia
    b. Total extra-peritoneal
    repairs in elderly patients. Int
    ❖ Tissue suture repair
    Surg. 2003;88:231–237. [PubMed]
    a. Bassini and Shouldice technique and its
    11. Amid PK. Lichtenstein tension-free hernioplasty:
    modifications
    its inception, evolution, and
    b. Marcy repair [9] [10]
    principles. Hernia. 2004;8:1–7. [PubMed]
    Lichtenstein and laparoscopic techniques are
    12. Barkun J, Neville A, Fitzgerald GW, Litwin D,
    common and preferable ones. [9] [10]
    Evidence-Based Reviews in Surgery Group.
    Canadian Association of General Surgeons.
    The mesh used for the Lichtenstein repair also known
    American College of Surgeons Canadian
    as meshplasty comes in different forms:
    Association of General Surgeons and American
    o Synthetic mesh
    College of Surgeons evidence-based reviews in
    1. Heavy weight
    surgery. 26. Watchful waiting versus repair of
    a. Polypropylene
    inguinal hernia in minimally symptomatic
    b. polyester
    men. Can J Surg. 2008;51:406–409.[PMC free
    2. Light weight
    article] [PubMed]
    i. Non-absorbable
    • Plain polypropylene

    www.iajps.com Page 140


    IAJPS 2020, 07 (10), 138-141 Rabia Ramzan et al ISSN 2349-7750

    13. Chung L, Norrie J, O'Dwyer PJ. Long-term


    follow-up of patients with a painless inguinal
    hernia from a randomized clinical trial. Br J
    Surg. 2010 doi:10.1002/bjs.7355. [PubMed]
    14. Sanchez-Manuel FJ, Lozano-García J, Seco-Gil
    JL. Antibiotic prophylaxis for hernia
    repair. Cochrane Database Syst
    Rev. 2007;3 CD003769.
    15. Yerdel MA, Akin EB, Dolalan S, Turkcapar AG,
    Pehlivan M, Gecim IE, et al. Effect of single-
    dose prophylactic ampicillin and sulbactam on
    wound infection after tension-free inguinal
    hernia repair with polypropylene mesh: the
    randomized, doubleblind, prospective trial. Ann
    Surg. 2001;233:26–33.[PMC free
    article] [PubMed]

    www.iajps.com Page 141

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