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Abstract：
BACKGROUND: Double direct and triple indirect type hernia in unilateral inguinal hernia is unique. Anomaly of pathway traversed by inferior epigastric artery is always of surgical importance. Meticulous exploration of the groin is mandatory for diagnosis of rare hernia.
METHODS: A 46 year old male presented with the right groin swelling. An inguinal hernia having two direct types separated by anamalous inferior epigastric artery and three indirect types of hernia were present. There was one bubonocele and two funicular types of indirect type of hernia present on the single cord. Anamalous inferior epigastric artery lying superficially at midpoint of inguinal canal was buttresed in the posterior wall to prevent its entrapping in mesh. Individual ligation of the indirect sacs and Lichtenstein repair was done. This is first kind of unique case report with the new type of hernia reported in the English literature after searching Pubmed, Medline, Google Scholar and Embase database. This new hernia, Double Pantaloon hernia, as a mark of respect and unity, is named after its State of origin, \"Jammu, Kashmir and Ladakh\" so called as \"Jammu Kashmir and Ladakh Hernia\".
CONCLUSIONS: Double direct and triple indirect type hernia in a unilateral inguinal hernia is unique. Presence of multiple hernia sacs in the inguinal hernia is a risk for recurrence, if not detected. Inferior epigastric artery in inguinal canal may traverse an aberrant course.
METHODS: A 46 year old male presented with the right groin swelling. An inguinal hernia having two direct types separated by anamalous inferior epigastric artery and three indirect types of hernia were present. There was one bubonocele and two funicular types of indirect type of hernia present on the single cord. Anamalous inferior epigastric artery lying superficially at midpoint of inguinal canal was buttresed in the posterior wall to prevent its entrapping in mesh. Individual ligation of the indirect sacs and Lichtenstein repair was done. This is first kind of unique case report with the new type of hernia reported in the English literature after searching Pubmed, Medline, Google Scholar and Embase database. This new hernia, Double Pantaloon hernia, as a mark of respect and unity, is named after its State of origin, \"Jammu, Kashmir and Ladakh\" so called as \"Jammu Kashmir and Ladakh Hernia\".
CONCLUSIONS: Double direct and triple indirect type hernia in a unilateral inguinal hernia is unique. Presence of multiple hernia sacs in the inguinal hernia is a risk for recurrence, if not detected. Inferior epigastric artery in inguinal canal may traverse an aberrant course.
摘要：
背景：单侧腹股沟疝的双直接型和三间接型疝是独特的。腹壁下动脉穿越的路径异常始终具有手术重要性。对于罕见疝的诊断，必须仔细探查腹股沟。
方法：46岁男性，右侧腹股沟肿胀。存在腹股沟疝，该腹股沟疝具有两种直接类型，由上腹下动脉和三种间接类型的疝分开。单索上有1例漏斗囊肿和2种间接型疝。位于腹股沟管中点表面的上腹下动脉在后壁被阻塞，以防止其陷入网状。进行了间接囊的单独结扎和Lichtenstein修复。这是在检索Pubmed后，英文文献中首次报道的新型疝气的独特病例报告，Medline,GoogleScholar和Embase数据库。这种新的疝气,双Pantaloon疝,作为尊重和团结的标志，以其起源国命名，\"查谟,克什米尔和拉达克被称为“查谟克什米尔和拉达克赫尼亚”。
结论：单侧腹股沟疝的双直接型和三间接型疝是独特的。腹股沟疝中存在多个疝囊是复发的风险，如果没有检测到。腹股沟管中的上腹部下动脉可能穿过异常的过程。
方法：46岁男性，右侧腹股沟肿胀。存在腹股沟疝，该腹股沟疝具有两种直接类型，由上腹下动脉和三种间接类型的疝分开。单索上有1例漏斗囊肿和2种间接型疝。位于腹股沟管中点表面的上腹下动脉在后壁被阻塞，以防止其陷入网状。进行了间接囊的单独结扎和Lichtenstein修复。这是在检索Pubmed后，英文文献中首次报道的新型疝气的独特病例报告，Medline,GoogleScholar和Embase数据库。这种新的疝气,双Pantaloon疝,作为尊重和团结的标志，以其起源国命名，\"查谟,克什米尔和拉达克被称为“查谟克什米尔和拉达克赫尼亚”。
结论：单侧腹股沟疝的双直接型和三间接型疝是独特的。腹股沟疝中存在多个疝囊是复发的风险，如果没有检测到。腹股沟管中的上腹部下动脉可能穿过异常的过程。
