Incarcerated femoral hernia containing ovary and fallopian tube in a 54-year-old

Transabdominal Preperitoneal Repair for an External Supravesical Hernia With an Incarcerated Ovary: A Case Report

External supravesical hernias with ovarian incarceration have not been reported previously. Here, we describe transabdominal preperitoneal (TAPP) repair of an external supravesical hernia with ovarian incarceration. A 68-year-old woman presented to our outpatient clinic with the chief complaint of right inguinal swelling and pain. A 3-cm-diameter mass in the right inguinal region that was difficult to reduce was palpable, and computed tomography (CT) revealed a suspicious lesion of the right hydrocele of the canal of Nuck. Hydrocelectomy was performed through an inguinal incision, and the external inguinal ring was repaired using the Marcy method. The histopathological examination confirmed the diagnosis of the canal of Nuck. Three months postoperatively, the patient again presented with right inguinal pain, and CT revealed a right femoral hernia requiring surgical repair. Intraoperative findings revealed a right external supravesical hernia with an incarcerated ovary, which was laparoscopically reduced and repaired with a mesh. At the three-month follow-up, there were no postoperative complications or recurrences. Incarcerated ovaries with inguinal hernias have been reported in girls; however, incarcerated ovaries with external supravesical hernias have not been reported in women. Although the preoperative diagnosis was difficult to make in this case, the laparoscopic approach led to the diagnosis and successful mesh repair. Although optimal mesh repair of external supravesical hernias using TAPP has not been established, we believe that 2-5 cm around the hernial orifice, the Hesselbach triangle, and the lateral triangle should be covered with mesh.

Laparoscopic repair of irreducible femoral hernia containing the fallopian tube alone: a case report

BACKGROUND

We offer the first report of laparoscopic repair of an irreducible femoral hernia containing the fallopian tube alone.

CASE PRESENTATION

An 84-year-old woman presented with a 2-week history of a right groin mass with no abdominal symptoms. The mass was located below the inguinal ligament but showed no redness or tenderness. Abdominal computed tomography demonstrated a 4 × 3-cm cystic mass and enhanced cord-like structure in the right groin area. Hernia contents were considered potentially associated with the appendix, and right femoral hernia incarceration was diagnosed. We performed emergency surgery using a laparoscopic approach, revealing an irreducible femoral hernia containing the right fallopian tube, which was reduced laparoscopically. The reduced fallopian tube showed no ischemic changes, obviating the need for resection. No other abdominal organs such as the ovary, fimbriae of the fallopian tube, or appendix were incarcerated. We repaired the femoral hernia laparoscopically using a transabdominal preperitoneal approach with a mesh.

CONCLUSIONS

A laparoscopic approach offers ready and accurate confirmation of incarcerated or irreducible organs, rapid recovery, and favorable cosmesis and should therefore be considered for the treatment of incarcerated or irreducible femoral hernia.

Metastatic ovarian carcinoma presenting as an incarcerated femoral hernia

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Occasionally unusual abdominal structures may be found within the hernia sacs.

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Abdominal malignancies have the potential to seed any part of the peritoneum.

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Surgeons should be vigilant where there is a known intra-abdominal malignancy & the presence of an incarcerated hernia.

Introduction

Incarcerated femoral hernias usually contain a simple loop of bowel. Occasionally other abdominal structures may be found within the hernial sac. Rarely femoral hernias may contain metastatic tumour deposits.

Presentation of case

We report the case of an 82 year old lady with a background of ovarian carcinoma, who presented with acute small bowel obstruction and an irreducible right groin mass. CT imaging revealed an incarcerated loop of small bowel within a femoral hernia sac. The patient proceeded to theatre for hernia repair. Upon opening the hernial sac an adherent incarcerated small bowel loop was discovered. Interestingly, the sac itself was lined with metastatic deposits, which were later histologically proven to be ovarian in origin. The sac was reduced and the hernia was repaired. The patient’s post-operative course was uneventful.

Discussion

As abdominal wall hernias communicate with the abdominal cavity there is the potential for malignant cells to seed the peritoneal lining of the hernia sac. If the sac also contains bowel wall, this may become involved in the tumour mass. This may result in small bowel incarceration & obstruction.

Conclusion

In cases, where there is a known intra-abdominal malignancy & the presence of an incarcerated hernia, there should be a high index of suspicion for the presence of tumour within the hernial contents.

CT, MRI and laparoscopy findings of a retroperitoneally herniated ovary causing acute abdominal pain

We report a case of a young woman presenting with abdominal pain due to a rare and recurrent herniation of the ovary, to a retroperitoneal location lateral to the external iliac artery and directly dorsal to the iliopsoas muscle. Correlation between computed tomography, magnetic resonance imaging and laparoscopy is presented. The patient's complaints subsided after right oophoropexy. When aware, this diagnosis is easy to make and may allow symptomatic patients to be treated with laparoscopic oophoropexy.

Recurrent femoral hernia and associated ovarian pathology

The following case describes an ovarian tumour presenting in a highly unusual manner-in the form of a recurrent femoral hernia. Recurrent femoral herniae are unusual and should prompt awareness of underlying pathology causing increased intra-abdominal pressure.