Novosti
Khirurgii

DOI: https://dx.doi.org/10.18484/2305-0047.2016.6.617   |  

V.I. BELOKONEV ¹, S.M. PIKALOV ², S.Y. PUSHKIN ², A.N. ZHDANOVA ¹

GIANT SLIDING INGUINAL SCROTAL HERNIA OF THE BLADDER

FSBEE HE "Samara State Medical University" ¹,
SBME "Samara Regional Clinical Hospital named after V.D. Seredavin" ²,
Samara,
The Russian Federation

A clinical observation of 64-year-old patient with giant sliding inguinal scrotal hernia, suffering from third-degree obesity is presented in this article. On admission the patient complained that the scrotum gradually increased in size to the extent of impairing free movement and urinary tract disorders. He has been ill since 1991, when a tumor-like formation developed in the right groin after lifting a heavy object and gradually began to increase in size. The patient appealed to a physician only in 2015 due to his inability to urinate otherwise than in the in lying position by pressure on the scrotum. The patient was operated on and during the operation a combined right-sided huge oblique congenital hernia, complicated by hydrocele, which couldn’t be reset and and direct sliding inguinal hernia containing the ureter and bladder had been revealed. With some technical difficulties the fibro-changed huge hernia sac with a testicle was initially isolated. After isolation and treatment, the neck of the spermatic cord was tied off, the hernia sac with the right testicle were removed. Its stump after the closure with the internal purse-string suture was loaded in the preperitoneal space. When this stage was completed medially in relation to the removed hernia sac a tumor-like large formation remained in the scrotum. The right ureter and most part of the bladder were found in division of tumor-like formation. The bed was prepared via the suprapubic access in the preperitoneal space, in which via the window in the transverse fascia in the projection of the medial inguinal fossa the bladder and right ureter were displaced and the epicystostomy was imposed. In the inguinal canal the stitching of the transverse fascia was carried out, after that its posterior wall was reinforced with synthetic prosthesis, covering both inguinal fossae.Operation was completed by scrotal excision and reconstruction with skin grafts plasty. The incisional period was uneventful. The point of this observation is the rarity of this disease and the difficulty of preoperative diagnosis established clinically only. An exact diagnosis was established only during the operation. Inguinal-scrotal chronic hernia is a complex surgical pathology. Prevention of the formation of these hernias is considered to be as an early surgical treatment. One peculiarity is worthy of notice: the performance of scrotal plasty is an attempt to avoid complications and to improve the outcome of treatment.

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