Concluded Case

Evaluation of Groin swelling

A 55 year male patient presented with a swelling rt groin gradually increasing in size for >one year associated with occasional pain. No vomiting/ abd distention/constipation Past history Rt inguinal hernia hernia repair in 2018 CHD Thrombocytopenia Platelets count < 80000 O/E A swelling palpable Rt groin approx 15×10 cm With palpable impulse on coughing, comressible,partially irreducible,cystic, trasilluminant,below the inguinal ligament and lateral to pubic tubercle. No evidence of varicose veins lower limb No complete disappearance of swelling on lying down. Swelling non pulsatile. No venous hum/ murmur on auscultation. Consultation with previous surgeon Recurrent RIH suggested reoperation USG Abd recurrent rt inguinal hernia.Liver normal,no splenomegaly,no portal vein dilatation. Based on my clinical findings my D/ D was Femoral hernia with hydrocele of the sac Lymph Varix MRI Rt groin and pelvis suggested Saphena Varix with Ascites in the pelvic region Patient was advised Exploration and proceed Operative notes A 6 to 7 cm incision was given 2 cm below and parallel to the inguinal ligament. On exploration a retort shaped sac was isolated exiting the femoral canal.Sac was containing fluid slightly hemorrhagic, no omentum/but Herniotomy was done and stump transfixed with vicryl.Femoral ring was closed with figure of eight prolene. Repair strengthened with a flap of fascia from pectineus muscle sutured with prolene continuously Routine wound closure. No Drain. Fluid from hernial sac sent for Routine exam,ADA,AFB,and malignant cells Reports awaited Message Recurrence of inguinal hernia Direct/Indirect is a known complication Development of Femoral hernia after surgery for inguinal hernia is very rare Rely on your clinical findings rather on the investigation reports Always correlate the investigation reports with your clinical findings The ratio of Male Female femoral hernia is 1:4 In repair of Femoral hernia injury to femoral vein and bladder should always be kept in mind. I will be sharing the Histopathological report and Fluid of hernial sac which was communicating with the peritoneal cavity

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It is customary to jump to conclusion that rt inguinal swelling after right inguinal herniorrhaphy ,should be recurrence of right inguinal hernia. Clinical examination brought light and dispelled this confusion. Great job,thanks for sharing

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It is a case of hydrocele of the femoral hernia sac or femorocele. Very rare case. Preoperatively even wtih USG diagnosis is defficult. Excision of sac of femoral hernia with herniotomy then repair of femoral hernia with apposition of pectineal part of ingunal hernia anterorly and inguinal ligament posteriorly.

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It is customary to jump to conclusion that rt inguinal swelling after right inguinal herniorrhaphy ,should be recurrence of right inguinal hernia. Clinical examination brought light and dispelled this confusion. Great job,thanks for sharing

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1

Absolutely great and clear masage Yes clinical experience and examination are more important Yes rest are corelating They are useful when clinical examination is suspicious Well done sir

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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Thank you for your nicely explained femoral hernia with hydrocele management and finding Dr. Ajit Jangbahadur sir

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Its a case if inguinal hernia Surgical under GA

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Your shareing very studied and helpful to us

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Excellent you people are institution

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Very intelligent post sir God bless you

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Inguinal hernia, recurring

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