Multiple concurrent bilateral groin hernias in a single patient; a case report and a review of uncommon groin hernias: A possible source of persistent pain after successful repair. (2016)

• Record Type: Journal Article
• Authors: Matsevych, O.Y.; Koto, M.Z.; Becker, J.H.R.
• Is Part Of: International journal of surgery case reports. Volume 29(2016)
• Page Start: 204
• Page End: 207
• Publication Date: 2016
• Subjects: Multiple groin hernias -- Rare groin hernia -- Occult groin hernia -- Laparoscopic preperitoneal mesh repair; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2016.11.019
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: An occult hernia is a hernia where physical examination fails to demonstrate a hernia mass or defect, but a hernia is identified on surgical exploration. Multiple simultaneous occult hernias can be completely asymptomatic or it may present with unexplained chronic groin or pelvic pain. MRI is the most accurate preoperative and postoperative diagnostic tool to image an occult hernia. Preperitoneal endoscopic approach is the recommended method in diagnosing and treating occult groin hernias. A sound knowledge of groin anatomy and thorough preperitoneal inspection of all possible sites for rare groin hernias is needed to diagnose and treat all defects. Abstract: Introduction: The wide use of laparoscopy for groin hernia repair has unveiled "hidden hernias" silently residing in this area. During the open repair of the presenting hernia, the surgeon was often unaware of these occult hernias. These patients postoperatively may present with unexplained chronic groin or pelvic pain. Presentation of case: Rare groin hernias are defined according to their anatomical position. Challenges in the diagnosis and management of occult rare groin hernias are discussed. These problems are illustrated by a unique case report of multiple (six) coexisting groin hernias, whereof five were occult and two were rare. Discussion: Rare groin hernias are uncommon because they are difficult to diagnose clinically and are not routinely looked for. They are often occult and may coexist with other inguinal hernias, thus posing a diagnostic and treatment challenge to the surgeon, especially if there is persistent groin pain after "successful" repair. MRI is the most accurate preoperative and postoperative diagnostic tool, if there is a clinical suspicion that the patient might have an occult hernia. Conclusion: Preperitoneal endoscopic approach is the recommended method in confirming the diagnosis and management of occult groin hernias. A sound knowledge of groin anatomy and a thorough preperitoneal inspection of all possible sites for rare groin hernias are needed to diagnose and repair all defects. The preperitoneal mesh repair with adequate overlap of all hernia orifices is the recommended treatment of choice.