Hernial sac tuberculosis an unusual presentation of. The tubercular pathology which affects primarily the peritoneum, can affect the hernia sac which can be encountered during routine herniotomy operation. The hernia was repaired with mesh with out complications. Hernia repair is one of the most common surgical procedures in all age groups. The inferior epigastric vessels circle are identified lateral to the hernia sac. Inguinal hernia accounts for about 75 per cent of all hernias. The sac was excised and sent for urgent histological examination. A 73 yearold man presented for right inguinal hernia repair. A doctor can often move an inguinal hernia back inside the abdominal wall with gentle massage.
Ectopic adrenal gland in an adult inguinal hernial sac. Finally a diagnosis of internal hernia with abdominal cocoon secondary to abdominal tuberculosis was made. Its association with multiple congenital anomalies in various organs is well recognized and antenatal radiological evidence of congenital diaphragmatic hernia warrants thorough evaluation to detect other anomalies, some of which can be life threatening. The histopathological examination of a hernia sac specimen may. The hernia a ventral hernia is a bulge through an opening in the muscles on the abdomen.
An uneventful open repair was done, and the resected hernial sacs were sent to pathology. Mesh can be directly identified when radiopaque material used, or indirectly by staples or suture calcifications recurrence rates following mesh repair vary based on technique, with a range of 510% at two years14. We divided the patients into four groups, according to the type of hernia. Serum ada and histopathology of mesenteric lymph node confirmed the tuberculosis.
Other hernias include hiatus, incisional, and umbilical hernias. Aug 20, 2019 patient data were evaluated retrospectively. The college of american pathologists recommends microscopic examination of abdominal hernias, but leaves submission of inguinal hernias for histology to the discretion of the pathologist. Among all age groups, inguinal hernia repair remains one of the most. American college of surgeons division of education ventral. Our aim was to investigate the pathologies in the hernia sac in adults, and the frequency of malignancy as well as to confirm. Incarcerated hernia definition of incarcerated hernia by.
The hyperplasia was of such a degree that a diagnosis of a neo plastic process of one type or another was. Left side congenital diaphragmatic hernia with sac and. Discussion congenital diaphragmatic hernia cdh has an incidence of 1 in 2000 to 5000 live births. The hernia sac is a common surgical pathology specimen which can occasionally. The remaining 10% are in miscellaneous locations eg, ventral incisional hernia. Jan 01, 2020 a 37yearold man was admitted for bilateral inguinal hernia. Table 2 pathology results of hernia sac specimens sent for.
Hernia sacs are sent to the pathology department, although there is a difference between clinics. Adrenal cortical heterotopia in an inguinal hernia. Right sided diaphragmatic hernia of morgagni with associated. Hiatal hernia has often been called the great mimic because its symptoms can resemble many disorders. If the hernia reduces in size when a person is lying flat or in response to manual pressure, it is reducible. The histopathology of the hernia sac ring was fibrous or fibromuscular tissue.
Samples were evaluated regarding me sothelial, smooth muscle, neuronal, adipose, and vascular tissue proliferation as well as inflammation. This may result in gastroesophageal reflux disease gerd or laryngopharyngeal reflux lpr with symptoms such as a taste of acid in the back of the mouth or heartburn. Clinical value of hernia mesh pathology evaluation journal of the. Approximately onehalf of these complications may require surgical reintervention, and accurate diagnosis at multidetector row ct is necessary for optimal patient treatment, 8, 32. Pathology outlines hernia sac with mesothelial entrapment. Although the practice of sending the hernia sac for histologic examination after routine hernia repair is common, the indications and practice patterns for this have not been evaluated. In 56 sacs the hernia sac ring hsr was present 36 rings in the elective and 20 rings in the sacs of incarcerated hernias. The tip of the appendix was adherent to the scrotal wall, where the pus was extruding out.
Abdominal wall herniae and their underlying pathology ncbi nih. Medcosmos surgery surgery lecture notes, books, mcq and good articles friday, september 5, 2008 hernia and acute abdomen. Case presentation a 37yearold man was admitted for. Groin hernias are most commonly of the inguinal type but may also be femoral. Inguinal hernia repair is one of the most common operations performed by pediatric surgeons.
As dissection proceeds, the contents of the hernia sac are reduced and the esophagus comes into view. Hence we suggest that during hernia repair, if the contents of the sac look suspicious, a biopsy should be taken for histopathology so that cases of tuberculosis can be diagnosed early and timely treatment can be started to decrease the rate of complications. An operation for a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removal of the hernia sac. The omentum was slightly thickened but there were no tubercles in the omentum suggestive of tuberculosis.
Article information, pdf download for pathology of the pediatric regio. Incidental microscopic finding of acellular mucin in an inguinal hernia sac as a warning sign of pseudomyxoma peritonei. Leftsided congenital diaphragmatic hernia with multiple. A hernia is strangulated if the intestine is trapped in the hernia pouch and the blood supply to the intestine is decreased. The purpose of histological examination is to detect a hidden malignancy. Histopathology confirmed hemorrhagic necrosis of ovarian tissues. They present with a lump in the side with a heavy, pulling. Dec 01, 2014 the hernial sac was ligated at the internal ring. Dec 02, 2020 amyands hernia is a rare condition approximately 0. By far the most common hernias up to 75% of all abdominal hernias are the socalled inguinal hernias. A hiatal hernia is a type of hernia in which abdominal organs typically the stomach slip through the diaphragm into the middle compartment of the chest.
We evaluated the demographic characteristics of the patients, the pathologies within the hernia sac, histopathological examination outcomes of the hernia sac and clinical features of malignancy in patients with malignancy. Congenital diaphragmatic hernia is a common congenital anomaly of uncertain etiology. A sac formed from the peritoneum and containing a portion of the intestine or omentum, or both, pushes either directly outward through the weakest point in the abdominal wall direct hernia or downward at an angle into the inguinal canal indirect hernia. Surgery lecture notes, books, mcq and good articles medcosmos surgery f r i d a y, s e p t e m b e r 5, 2 0 0 8 hernia and acute abdomen mcq 1. Intraoperatively, an inflamed and perforated appendix was found herniating into the right sac. Review of pathology and cost benefit analysis of hernia. The hernia was repaired with mesh without complications. Pdf is routine histological evaluation of pediatric hernial.
Pdf is routine histological evaluation of pediatric. Histopathology reported the presence of adrenocortical tissue in the. Pdf is histopathological evaluation of hernia sacs necessary. Materials and methods the database of the department of pathology were searched over the study period 2001 to 2019 inclusive for hernia sacs. The prognostic value of a hernia sac was studied by grizelj et al. Inguinal hernias may slide in and out of the abdominal wall. The initial appearance at exploration with bluish hernia sac. Diagnosis of inguinal region hernias with axial ct. An incarcerated or strangulated hernia is commonly presenting in amyands hernia, but it is classified as several types for variable presentation. However, the value of routine histologic examination of hernia sac tissues. Direct left inguinal hernia solid arrow containing fat. Article portuguese pdf article in xml format how to cite this article scielo analytics automatic translation.
Complications after surgical hernia repair may occur in up to 50% of cases, depending on surgical technique and the status of the hernia sac vasculature. Contents introduction general instruction grossing procedures by. Other symptoms may include trouble swallowing and chest pains. Leiomyomas are common benign gynecologic tumors occurring in up to 30% of women. This ring has its significance in the development of incarceration. One or two sections, including smooth lining and thickened areas. Histopathological fate in the inguinal hernia sac in the children. Loss of domain hernia sac volume divided by abdominal cavity volume, i. Intraoperative photograph showing a large nodule white asterix inside the hernia sac white arrow.
Intraoperatively, the mass was found to be a round ligament leiomyoma, a. Amyands hernia, neonatal appendicular perforation, neonatal appendicitis, inguinal hernia, acute scrotum, scrotal appendicitis, scrotal abscess, appendicectomy, herniotomy introduction claudius amyand, a french surgeon, first reported the successful removal of an inflamed appendix found within the sac of an inguinal hernia in an 11yearold. The total cost of complete pathology examination was calculated on average. Jun 22, 20 pdf the hernia sac is a common surgical pathology specimen which can occasionally yield unexpected diagnoses. The excessive amount of abdominal fluid causes raised intra abdominal pressure and can itself be the cause of the inguinal hernia or sometimes the umbilical hernia 1. Jun 22, 20 the hernia sac is a common surgical pathology specimen which can occasionally yield unexpected diagnoses. Mar 07, 2011 thus, the hernia neck will be superolateral to the course of the inferior epigastric vessels. The hernia sac is a common surgical pathology specimen which can occasionally yield unexpected diagnoses. Pdf ectopic adrenal gland in an adult inguinal hernial. Imaging complex ventral hernias, their surgical repair, and. Smf were observed in 76,5% of the patients with indirect hernia, 55,9% with direct hernia, 46,4% with strangulated hernia and 68,7% with recurrent hernia. Because of its varied presentation, clinical examination is o en inconclusive.
Abdominal wall herniae and their underlying pathology core. We report the case of a 47yearold woman who presented with an irreducible inguinal mass consistent with an incarcerated hernia. Introduction a 37yearold male patient operated for inguinal hernia repair was found to have ectopic adrenocortical tissue in the hernial sac. Most commonly they involve the abdomen, specifically the groin. The sac is then separated from the adjacent mediastinal structures with predominantly blunt dissection, and the sac is progressively reduced into the abdomen. Is histopathological evaluation of hernia sacs necessary. We describe a rare case of an 87yearold female patient who presented with an incarcerated right femoral hernia confirmed on contrastenhanced computed tomography scan of the abdomen and pelvis, with subsequent open hernia reduction revealing a perforated necrotic appendix with pus contained in the hernia sac. Inguinal hernia repair is one of the most common surger ies performed on children. In some cases, this is done using a single incision in your chest wall thoracotomy or abdomen laparotomy. Inguinal hernias are further divided into the more common indirect inguinal hernia 23, depicted here, in which the inguinal canal is entered via a congenital weakness at its entrance the internal inguinal ring, and the direct inguinal hernia type, where the hernia contents push. After histopathology examination, the type of cyst is classied as mesenteric chylous cyst.
Histopathology of nodule revealed sequestered lung tissue. However, the value of routine histologic examination of hernia sac tissues continues to. Amyands hernia is an uncommon form of inguinal hernia in which the appendix is incarcerated in the inguinal sac. Histopathology of the hernial sac in indirect inguinal hernia and in. Nov 01, 2005 complications after surgical hernia repair may occur in up to 50% of cases, depending on surgical technique and the status of the hernia sac vasculature. As the hernia sac protrudes further caudally, it is directed lateral to medial within the inguinal canal. Suspicious about the presence of a large amount of strawcolored fluid in the hernia sac, a biopsy of sac wall and omentum was taken and sent for histopathology. May 12, 2020 the hernia is defined as the passage of an organ or tissue from one anatomical region to another. Rarely, heterotopic hepatic tissue is identified in the.
Since the hernia sac might be the first clue for an underlying cancer, if abnormal pathological findings are detected during surgery, histopathological examination should be performed to exclude malignancy. Histopathology of the capsule wall and stricture site showed chronic nonspecific inflammatory reaction and mature fibrous tissue. Mesh can be directly identified when radiopaque material used, or indirectly by staples or suture calcifications recurrence rates following. Imaging complex ventral hernias, their surgical repair. In figures 8 and 9, note the origin of the hernia sac lateral to the course of the inferior epigastric vessels see also movies 4 and 5. Among them, a person with a hiatal hernia can experience dull pains in the chest, shortness of breath caused by the hernia s effect on the diaphragm, heart palpitations due to irritation of the vagus nerve, and swallowed food balling up and causing discomfort in the lower esophagus.
Approximately 1% of inguinal hernias contain a portion of the vermiform appendix. Out of 784 cases, 660 were elective and 124 incarcerated hernias. The objective of this survey was to determine practice patterns and indications for histologic. Aim hernia sacs with pathological evaluation over a 19year period were analysed with regards to pathological diagnoses, full costing and the impact on patient management. Jun 15, 20 of the hernia sac cannot be returned to the inguinal hernias are one of the most common reasons a primary care patient may need referral for surgical interven tion.
Histopathology fig 1 showed a thick inner wall composed of chronic inflammatory tissue containing lakes of mucin and welldifferentiated enteric type glandular epithelium with minimal cytonuclear atypia. Appendicectomy and bilateral herniotomy was done successfully and histopathology revealed acute appendicitis. Round ligament leiomyoma presenting as an incarcerated. When an inguinal hernia occurs, part of the peritoneumthe lining of the abdominal cavitybulges through the abdominal wall and forms a sac around the hernia. D uring the past 6 months, we have en countered four examples of florid meso thelial hyperplasia localized to the lining and content of a hernia sac. A constricting ring structure within the wall of the. Pdf the hernia sac is a common surgical pathology specimen which can occasionally yield unexpected diagnoses. Is histopathological evaluation of inguinal hernial sac necessary. Small glands, clusters, cords or individual mesothelial cells within the hernia sac usually no fat, muscle, stromal invasion or necrosis lacks grossly visible proliferation virchows arch a pathol anat histopathol 1989. The utility of pathologic evaluation of adult hernia specimens.
In our patient there was preoperative suspicion of ht which lead to close visual inspection of the sac tissue and later histopathological examination to confirm our suspicion of ht. The hernia sac is present in around 20 % of cdh patients. This is facilitated by an assistant pulling firmly downward on the sac. Mesenteric cysts is a rare pathologic entity that identied in approximately 1 out of 100,000 adult and 1 in 20,000 paediatric in hospital admissions 7. Amyands hernia associated with mesenteric chylous cyst in. Round ligament leiomyomas however are very rare and, if symptomatic, can present as an inguinal hernia. Amyands hernia presenting as a scrotal abscess a rare. If it cannot be reduced, it is irreducible or incarcerated, and a portion of the intestine may be bulging through the hernia sac. Approximately 5 cm added to each figure so as to obtain adequate overlap where necessary. American college of surgeons division of education groin. Overall, smf were found in 67,9% of the specimens, with larger incidence in the proximal portion of the hernia sac 53,2%. Histopathology reported the presence of adrenocortical tissue in the right inguinal hernial sac. A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Review of pathology and cost benefit analysis of hernia sacs.
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