Title: Stone in the hernial sac during inguinal hernioplasty- A case report and review of literature
Authors: Royson Dsouza, Victor Coelho, Sukriya Nayak
DOI: https://dx.doi.org/10.18535/jmscr/v8i1.48
Abstract
Inguinal hernia repair is one of the most common operations performed in general surgery worldwide. It may contain either the omentum or small bowel as its contents. However, during hernia surgery, there may be surprises due to encounter of rare or unexpected contents in the hernial sac. Among these are Meckel’s diverticulum, Amyand’s hernia, Rhicter’s hernia, bladder, fallopian tube and ovary. We present a case of herniolithiaisis which was a term given for ‘stone’ in the hernial sac by Singal et al., in their case report. The first case of stone in the hernial sac was reported by Mazdak et al in 2007. Our patient, a 56 year old diabetic gentleman presented with bilateral inguinal hernia, left larger than the right with a left hydrocele. He was posted for left hernioplasty and hydrocelectomy. Intraoperatively, a direct hernia with omentum and bowel as contents was seen. There was a 2x2 cm stone adherent to the omentum at the fundus of the sac. Biochemical analysis of the stone revealed calcium and oxalate as its main constituents. Herniolithiasis or stone in the hernial sac is an exceedingly rare entity. Chronic infection and inflammation of part of the omentum has been hypothesised to cause saponification, calcification and stone formation. In this report, we intend to present such an encounter during hernia surgery and briefly outline the other rare contents in the herinal sac. It is important that the operating surgeon is aware of various unexpected contents in the hernial sac during hernia repair in order to plan proper surgery.
Keywords: inguinal hernia, herniolithiasis, stone in hernial sac.
References
- Jenkins JT, Dwyer PJO (2008) Inguinal hernias. BMJ 336:269–272.
- Mongardini M, Merlino P, Schillaci F, Cola A, Blasi S, Fanello G et al. [Gangrene of Meckel's diverticulum in strangulated left inguinal hernia]. G Chir 2005; 26(10):384-386.
- Kulacoglu H, Tumer H, Aktimur R, Kusdemir A. Epiploic appendicitis in inguinal hernia sac presenting an inguinal mass. Hernia 2005; 9(3):288-290.
- Gupta S, Sharma R, Kaushik R. Left-sided Amyand's hernia. Singapore Med J 2005; 46 (8):424-425.
- Golash V, Cummins RS. Ovulating ovary in an inguinal hernia. Surgeon 2005; 3(1):48.
- Manatt S, Campbell JB, Ramji F, Kuhn A, Frimberger D. Inguinal herniation of the bladder in an infant. Can J Urol 2006; 13(2):3057-3058.
- Fumado CL, Rodriguez TJ, Pastor LS, Riera CL, Franco ME. [Massive bladder hernia]. Arch Esp Urol 2005; 58(10):1078-1080.
- Singal R, Mittal A, Gupta S et al., AN incarcerated appendix: report of three cases and a review of the literature Hernia 2012; 16:91-97.
- Brady RR, McAteer E, Weir CD. Biliscrotum and retroperitoneal biloma: spontaneous rupture of the biliary system presenting as an incarcerated inguinal hernia. Ulster Med J 2006; 75(1):85-87.
- Staniscia G, Graziani S, De Nicola E, Ciampaglia F. [Surprise in the hernia sac: the intrasaccular tumor of the sigma]. Ann ItalChir 2004; 75(5):599-601.
- Coelho Victor et al JMSCR Volume 06 Issue 06 June 2018.
- Rikki Singal, Maharishi Markandeshwar et al., A case of Inguinal hernia stone along with diabetes and pathophysiology. La Presse Medicale 2013. Doi: 10.1016/j.ipm.2012.11.022
- Mazdak H, Najafipour S. Hernial sac lithiasis, a rare presentation of inguinal hernia JRMS 2007; 12:49-51.4