7 / 10
Page 23
I n t e r n a t i o n a l C o n f e r e n c e o n
Physicians, Surgeons and
Case Reports
November 19-20 , 2018
Par i s , France
Medical Case Reports
ISSN: 2471-8041
PSCR 2018
Background:
The presence of all the gynecological organs in one side of female
inguinal hernia is very rare. Such findings in published papers are very few. The
diagnosis of such cases needs a high suspicion and is not necessary to do
ultrasound or CT scan unless there is a debate of the nature of the contents.
Case report:
Here in, we present a three months old female infant presented
with irreducible left inguinal hernia. The patient has history of reducible left
inguinal hernia since birth. The content was a reducible ovary. She was given
appointment for surgery but one week before surgery; appointment presented
with one day history of large left groin swelling, irreducible that suggested
that the contents are gynecological organs. Decision was taken for surgical
exploration without doing a pre-operative ultrasound or CT scan. We explained
to the parents, the possibility of finding torsion of an organ of the contents
which may necessitate its removal and the consent was taken. Operative
findings were the uterus, the two fallopian tubes and its two corresponding
ovaries were herniated out in the sac. Left ovary and tube were sliding. They
were in an inflamed condition with deep yellow serous fluid in the sac. The
ovaries were multi-cystic (multiple small cysts in both ovaries). All organs were
reduced to the abdominal cavity in specific sequences after widening of the
internal ring with a lateral incision. High closure and excision of the hernia sac
was done. Then repair of the defect was done and followed up for six months.
Ultrasound showed normal female organs in normal position.
Discussion:
Although this case appears simple but it has many challenges or
difficulties which should be considered in dealing with it. The first challenge
was in proper time of diagnosis to avoid torsion of one or both ovaries or even
the uterus. The other challenge is in dealing with the contents pre-operative;
don’t try to aggressively reduce the contents to avoid injury or torsion to these
important organs. The third challenge is inter-operative as the contents are
large and inflamed, while the neck of the hernia is narrow, so it needs a special
technique and maneuver to reduce them in safely.
Conclusion:
We prove that good clinical evaluation can be enough and no need
for ultrasonography or CT scan to reach a diagnosis or to take a decision for
surgery in case of irreducible female inguinal hernia. This condition is very rare
which needs good clinical expectation and gentle manipulation in reducing the
contents inter-operative. We advise to use the sequence we used to reduce
the herniated contents into the abdominal cavity following the role saying;
last organ came out is the first organ to go in. We expect that the left ovary
(ipsilateral ovary) came out first then the uterus which pulls the right ovary
up. So the last content herniates is the contra-lateral ovary, hence has to be
the first to go in. Also don’t hesitate to widen the internal ring to avoid hard
manipulation on reduction and the consequent organ injury.
Abnormal contents of female inguinal hernia of an infant
Hamid Qoura, Abdulrasheed, Ahmed Aboshosha, Moenes A L
Karim and Adil Mohamed
Nizwa Hospital, Oman
Hamid Qoura, Med Case Rep. 2018, Volume:4
DOI: 10.21767/2471-8041-C2-005
Biography
Dr Hamid Qoura, is Graduated fromKasr El-Aini medical school,
(Faculty of medicine Cairo University) 1983. Finished his
Master degree from the same college. Had MRCS from Ireland
and FEBPS from Glasgow. Had a diploma in laparoscopic
surgery from Strasbourg, France. He is working at present as
a consultant and HOD of Pediatric Surgery in Nizwa Hospital,
Oman. He published more than 10 papers in reputed Journals.
Has special interest in laparoscopic surgery. He is the first one
did real single port laparoscopic umbilical hernia, epigastric
hernia and divarication of recti repair. And can do throus the
same port inguinal hernias of the same patient.
qora21@gmail.com