Spigelian hernia with bilateral undescended (impalpable) testis in a child: rare scenario

Authors

  • Gaurav Singh Department of Paediatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
  • Garvita Singh Department of Paediatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
  • Satish K. Aggarwal Department of Paediatric Surgery, Sir Ganga Ram Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20210669

Keywords:

Inguinal, Swelling, Hernia, Spigelian

Abstract

Spigelain hernia (SH) is rarely seen in children. Various mechanisms has been described for the co-existence with cryptorchidism. A 4 month old boy, a known case of bilateral impalpable testes and intermittent right lower abdominal swelling was brought to paediatric emergency with complaints of excessive cry, poor feeding and irreducible right lower abdominal swelling - the swelling was a little higher than the usual inguinal hernia. On exploration, SH was seen coming off the deep ring then turning around the conjoint tendon and dissecting between internal oblique and external oblique aponeurosis. The hernia contained oedematous but viable gut with compression over the testicular vessels. Gut was viable. The testes was mobilized and fixed into the scrotum. Left testis was impalpable for which nubbin excision was done at a later date. A SH in the lower abdomen may be confused with a high inguinal hernia. In acute obstruction, emergent exploration and reduction is the cornerstone of treatment.

References

Singal AK, Ravikumar VR, Kadam V, Jain V. Undescended testis in spigelian hernia – A report of 2 cases and review of the literature. Eur J Pediatr Surg. 2011;21:194‐6.

Bilici S, Güneş M, Göksu M, Melek M, Pirinçci N. Undescended testis accompanying congenital spigelian hernia: Is it a reason, a result, or a new syndrome? Eur J Pediatr Surg. 2012;22:157‐61.

Mittal T, Kumar V, Khullar R, Sharma A, Soni V, Baijal M, et al. Diagnosis and management of spigelian hernia: A review of literature and our experience. J Minim Access Surg. 2008;4:95‐8.

Deshmukh SS, Kothari PR, Gupta AR, Dikshit VB, Patil P, Kekre GA, et al. Total laparoscopic repair of Spigelian hernia with undescended testis. J Min Access Surg 2019;15:265-7.

Aird I. Comparison in surgical studies, 2nd edn. Livingston, Edin- burgh London. 1957;652.

Graivier L, Bernstein D, RuBane CF. Lateral ventral (spigelian) hernias in infants and children. Surgery. 1978;83:288-90.

Spangen L. Spigelian hernia. Surg Clin North Am. 1984;64:351-66.

Al-Salem AH. Congenital spigelian hernia and cryptorchidism: cause or coincidence? Pediatr Surg Int. 2000;16(5-6):433-6.

Durham MM, Ricketts RR. Congenital spigelian hernias and cryptorchidism. J Pediatr Surg. 2006;41(11):1814-7.

Raveenthiran V. Congenital Spigelian hernia with cryptorchidism: probably a new syndrome. Hernia. 2005;9(4):378-80.

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Published

2021-02-23

Issue

Section

Case Reports