Congenital Spigelian hernia associated with undescended testis
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Congenital Spigelian hernia associated with undescended testis Mustafa Inan, Umit Nusret Basaran, Burhan Aksu, Zafer Dortdogan, Murat Dereli Edirne, Turkey
Methods: A 20-day-old newborn was admitted to our hospital for a swelling in the right lower abdomen and undescended testis. Physical examination of the abdomen and scrotum revealed a congenital SH associated with cryptorchidism. Results: Herniotomy, herniorrhaphy, and orchidopexy were performed. In the post-operative period, scrotal abscess occurred and was drained. After drainage, the fixed testis was found to be atrophic. Conclusions: This association may be a distinct clinical syndrome. The operation time in cases of neonatal SH with undescended testis should be well planned because of probable surgical complications such as vascular damage, tension, or compression. World J Pediatr 2012;8(2):185-187 Key words: congenital Spigelian hernia; testicular atrophy; undescended testis
Author Affiliations: Department of Pediatric Surgery, Trakya University Faculty of Medicine, Edirne, Turkey (Inan M, Basaran UN, Aksu B, Dortdogan Z, Dereli M) Corresponding Author: Mustafa Inan, MD, Department of Pediatric Surgery, Trakya University Faculty of Medicine, 22030, Edirne, Turkey (Tel: +90 284 2357641; Fax: +90 284 2357652; Email: mustafainan@ trakya.edu.tr) doi: 10.1007/s12519-011-0313-5 ©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2011. All rights reserved.
World J Pediatr, Vol 8 No 2 . May 15, 2012 . www.wjpch.com
Introduction
S
pigelian hernia (SH) is a rare condition firstly described in 1764, whose typical patient profile is of an overweight 50-year-old with associated respiratory disease.[1] By contrast, its occurrence as a congenital hernia was firstly described in 1935.[2] Since then, 54 cases of SH have been reported in infants or children.[1,3-6] However, SH associated with undescended testis cases are extremely rare in the literature. We present a case with a review of the literature concerning the pathogenesis, diagnostic methods, and treatment of SH.
Case report
A boy born with a non-palpable right testicle was observed by his parents to have an intermittent swelling in the right lower abdomen. An abdominal wall swelling was especially noticeable when crying. The boy was born at full-term after an uneventful pregnancy, weighing 2900 g with a length of 48 cm and a head circumference of 36 cm. The boy was aged 26 days at diagnosis. Upon examination, the left testis was found to be normal in size with hydrocele and situated within the scrotum. The right testis was not palpable. When straining, a reducible hernia containing a 3 cm mass was found at the lateral border of the right rectus abdominis muscle about 3 cm above the inguinal canal (Fig. A and B). Ultrasonography of the swelling revealed a fascial plane defect through the linea semilunaris with herniation of bowel loops between the internal and external oblique muscles, consistent with a SH. Moreover, ultrasonography of the inguinoscrotal
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