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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 5  |  Issue : 2  |  Page : 89-91

Ileo-ovarian knotting in a case of strangulated inguinal hernia in a 46-year-old female: A first case report


Department of General Surgery, Teerthankar Mahaveer Medical College, Moradabad, Uttar Pradesh, India

Date of Web Publication26-Jul-2017

Correspondence Address:
Neha Ramesh Mutha
Department of General Surgery, Teerthankar Mahaveer Medical College, Delhi Road, Moradabad - 244 001, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ssj.ssj_94_16

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  Abstract 

Ileo-ovarian knotting in a case of strangulated inguinal hernia, reported herein, has never been reported before. We believe this case is of great importance because of its absolute rarity. A 46-year-old female came with right inguinal swelling, vomiting, and abdominal distension for 2 years but aggravated during the last week. She had passed stools 24 h ago and was vomiting since then. The abdomen was distended as well as tenderness and guarding was noted in the lower abdomen. Examination revealed strangulated right inguinal hernia with abdominal X-ray suggestive of acute small bowel obstruction. Abdominal ultrasonography revealed dilated small bowel loops and aperistaltic edematous intestines in the right inguinal region; an urgent surgery was, hence, planned. Exploration revealed ileo-ovarian knotting with one-foot gangrene of small bowel and strangulated right ovary. Resection of the right ovary, bowel resection, and end-to-end anastomosis with hernioplasty were performed. The patient recovered well in the postoperative period.

Keywords: Ileo-ovarian knotting, strangulated inguinal hernia, female inguinal hernia


How to cite this article:
Khan MA, Mutha NR. Ileo-ovarian knotting in a case of strangulated inguinal hernia in a 46-year-old female: A first case report. Saudi Surg J 2017;5:89-91

How to cite this URL:
Khan MA, Mutha NR. Ileo-ovarian knotting in a case of strangulated inguinal hernia in a 46-year-old female: A first case report. Saudi Surg J [serial online] 2017 [cited 2019 Aug 25];5:89-91. Available from: http://www.saudisurgj.org/text.asp?2017/5/2/89/211616


  Introduction Top


Strangulated inguinal hernia has an overall prevalence of 1.3% in adults, affecting mainly senile patients, with a high incidence of morbidity and mortality. Strangulated inguinal hernia requires urgent surgical therapy. The hernial contents generally include the omentum and small intestines. Cases of hernia associated with gastric, ovarian, and appendiceal strangulation and Meckel's diverticulum have also been reported, though these cases are rare.[1] However, a case of the ileo-ovarian knotting in a case of strangulated inguinal hernia, reported herein, has never been reported before. We believe that this case is of great importance because of its absolute rarity.


  Case Report Top


A 46-year-old female visited the hospital with complaints of right inguinal swelling, pain spreading from the right inguinal region to the entire body, vomiting, and abdominal distension. The swelling persisted for almost 2 years, for which she was advised surgery but was lost to follow-up and the pain had increased considerably during the last week. She had passed her stools 24 h ago and had been vomiting since then. There was no history of any chronic disease or any regular medication. She had no history of any surgical interventions in the past. With respect to the reproductive history, she had conceived thrice and had regular menstrual cycle. On clinical examination, the abdomen was distended along with tenderness, and guarding at the lower abdomen was noted. Examination of the right groin revealed a strangulated right inguinal hernia [Figure 1]. Rectum was found to be empty during rectal examination. Systemic examination was unremarkable. On radiographic evaluation, air–fluid level was noted on the direct abdominal X-ray film obtained in the erect position, suggestive of acute small bowel obstruction. Laboratory investigations revealed white blood cell count of 16,000/μL and other parameters were within the normal range. Ultrasonography of the abdomen revealed dilated small bowel loops without free fluid and the right inguinal region revealed aperistaltic edematous intestines, which was indicative of inguinal hernia; an urgent surgery was, hence, planned. Exploration of the right inguinal region on surgery under general anesthesia revealed ileo-ovarian knotting with gangrene of one foot of small bowel and strangulated right ovary [Figure 2] and [Figure 3]. Resection of the right ovary, bowel resection, and end-to-end anastomosis with hernioplasty were performed. The patient recovered well in postoperative period and was discharged on the 5th postoperative day without any complications. The patient did well in postoperative follow-up for 6 months.
Figure 1: Right groin swelling. Courtesy of Khan MA, Uttar Pradesh, India

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Figure 2: Strangulated ovary in the right inguinal canal. Courtesy of Khan MA, Uttar Pradesh, India

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Figure 3: Strangulated bowel (black arrow); bowel strangulation around ovarian pedicle (blue arrow); strangulated ovary (purple arrow). courtesy of Khan MA, Uttar Pradesh, India

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  Discussion Top


The increasing awareness and developments in patient care and treatment in the recent years has led to an increasing concern regarding strangulated inguinal hernia.[2],[3] It has been reported that 20% and 5% of all hernia cases in women and men, respectively, are those of femoral hernia, and this rate increases further in the elderly.[4] The risks of strangulation and other complications that arise from late diagnosis have been examined in detail in the literature.[2] A systematic review with meta-analysis was conducted in which they concluded that the mesh repair technique is a good option for the treatment of strangulated inguinal herniae in adults.[4]

In another study of laparoscopic versus open repair for strangulated groin herniae, they concluded that emergency laparoscopic repair for strangulated groin herniae is feasible and appears to have a lower morbidity relative to open repair.[5]

As previously stated, the presence of appendix, ovaries, and Meckel's diverticulum in the hernial sac, all of which are rare occurrences, has already been reported.[6],[7],[8] However, our literature search did not show any evidence of a case of ileo-ovarian knotting in a case of strangulated inguinal hernia. This should be considered, particularly in the reproductive age group; the complications can range from ovarian torsion to total ischemia and necrosis of the uterus and ovary. Another parameter worth considering is the contribution of the location of intra-abdominal solid organs in the hernial sac. Taken together, we can conclude that, in cases of strangulated inguinal hernia, the uterus and ovaries should be considered as possible hernial contents and sufficient exploration should be carried out; this is important not only for avoiding small intestinal resection but also for preserving reproductivity and prohibiting postoperative morbidity and mortality. This becomes even more important when the patient is a female and in the reproductive age group.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Weir CD, Doan SJ, Lughlin V, Diamond T. Strangulation of the appendix in a femoral hernia sac. Ulster Med J 1994;63:114-5.  Back to cited text no. 1
    
2.
Heys SD, Brittenden J. Strangulated femoral hernia: The persisting clinical trap. Postgrad Med J 1991;67:57-9.  Back to cited text no. 2
    
3.
Akçakaya A, Alimoglu O, Hevenk T, Bas G, Sahin M. Mechanical intestinal obstruction caused by abdominal wall hernias. Ulus Travma Derg 2000;6:260-5.  Back to cited text no. 3
    
4.
Hentati H, Dougaz W, Dziri C. Mesh repair versus non-mesh repair for strangulated inguinal hernia: Systematic review with meta-analysis. World J Surg 2014;38:2784-90.  Back to cited text no. 4
    
5.
Yang GP, Chan CT, Lai EC, Chan OC, Tang CN, Li MK. Laparoscopic versus open repair for strangulated groin hernias: 188 cases over 4 years. Asian J Endosc Surg 2012;5:131-7.  Back to cited text no. 5
    
6.
Scherer LR 3rd, Grosfeld JL. Inguinal hernia and umbilical anomalies. Pediatr Clin North Am 1993;40:1121-31.  Back to cited text no. 6
    
7.
George EK, Oudesluys-Murphy AM, Madern GC, Cleyndert P, Blomjous JG. Inguinal hernias containing the uterus, fallopian tube, and ovary in premature female infants. J Pediatr 2000;136:696-8.  Back to cited text no. 7
    
8.
Jedrzejewski G, Stankiewicz A, Wieczorek AP. Uterus and ovary hernia of the canal of Nuck. Pediatr Radiol 2008;38:1257-8.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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