A differential diagnosis in chronic lower abdominal pain

Giant interparietal inguinal hernia with undescended testis-A Rare case report

•

An interparietal inguinal hernia with undescended testis & obstructed external ring is a rare presentation.

•

In Interperital hernia, the sac passes between the layers of the abdominal wall.

•

Pre-operative diagnosis even with the help of USG & CT is really a challenging issue.

•

Treatment is surgical exploration which also confirms the final diagnosis.

Introduction

An interparietal inguinal hernia is a rare form of hernia. In this type of hernia, the sac passes between the layers of the abdominal wall of the inguinal canal area. Although its treatment is very simple but pre-operative diagnosis is really a challenging issue.

Presentation of case

A 62 years old male patient presented with complaint of a large swelling over right lower abdomen with absence of right testes since birth. The lump was measured 26 × 22 cm in size. Ultrasonography (USG) and Contrast enhanced computed Tomography (CECT) failed to diagnose as interparietal inguinal hernia which was proved intra-operatively. Few cases have been reported in the medical literature like this.

Discussion

Exploration revealed the large abdominal lump presenting as an interparietal inguinal hernia. Hernia sac was lying in between external & internal oblique muscles. The right testis was intraabdominal & atrophied. The external inguinal ring was almost completely obstructed.

Conclusion

An interparietal hernia with undescended testis is a very rare presentation. Even with USG & CT scan diagnosis is very challenging and final diagnosis can be made only intraoperatively.

[Spigelian hernias]

Spigelian hernias represent 1-2% of all abdominal wall hernias. The pathogenesis often involves a dehiscence of the transverse and internal oblique muscle aponeurosis. The diagnosis is made by physical examination; but sometimes it is complicated by obesity. The risk of strangulation is important and can reach 30%. The abdominal CT scan is helpful in the description of hernia's topography and sometimes in diagnostic confirmation. The treatment is surgical. The rate of recurrence after direct closure is considerable. Synthetic mesh repair seems to be a more adequate alternative. The advent of laparoscopy has improved the management of these hernias.