UNASSIGNED: Reduction en masse is a rare complication of incarcerated inguinal hernias, occurring when the herniated sac, along with the trapped hernia, returns to the preperitoneal space.
METHODS: In this study, we describe a 74-year-old male patient who presented to the hospital with a history of manual hernia reduction and complaints of nausea, vomiting, and constipation for two weeks. After undergoing paraclinical tests, he underwent open surgery with a diagnosis of hernia reduction en masse, during which the hernia sac was separated from the surrounding structures. Abdominal and peritoneal defects were also repaired intra-abdominally. After his condition stabilized, the patient was discharged with prescription medications.
CONCLUSIONS: Reduction en masse in inguinal hernia cases is rare, where the hernia sac and intestinal contents are reduced while the intestine remains incarcerated. Computed tomography (CT) scans can aid in diagnosis, revealing characteristic features such as closed-loop obstruction and inguinal soft tissue changes. Treatment options include open laparotomy and laparoscopy, with laparoscopy being preferred depending on surgeon expertise, assessment of intestinal viability post-reduction, and patient stability.
CONCLUSIONS: The potential complications of hernia reduction en masse should be emphasized to patients who choose not to remain under medical supervision, as well as to physicians and surgeons when patients re-present following manual hernia reduction. Increasing awareness about this condition at relevant times is crucial.

Inguinal hernias involving the bladder are exceedingly rare and pose a diagnostic challenge. Identifying bladder involvement within an inguinal hernia is imperative to avoid iatrogenic bladder injuries and subsequent complications. Here we discuss a case of inguinal bladder herniation and bladder visualization using methylene blue dye intraoperatively. We present a case of a 45-year-old male who presented with a six-hour history of dysuria and a painful non-reducible right-sided groin mass that had previously been reducible for 17 years. Computed tomography demonstrated an irreducible indirect inguinal hernia-containing bladder. Open Lichtenstein repair was performed, and intraoperative methylene blue-dyed saline successfully identified the herniated bladder, preventing iatrogenic bladder injury. This case report demonstrates the importance of preoperative imaging and intraoperative visualization for the prevention of complications in a rare occurrence of a strangulated indirect inguinal hernia-containing bladder.

Colorectal cancer is the most frequently diagnosed neoplasm in the population worldwide, regardless of sex. Its presentation is variable, from asymptomatic cases that are diagnosed in the population screening programme, to perforation or intestinal obstruction that appear urgently. The location of the neoplasia inside an inguinal hernia, although it is described in the literature, is uncommon and may increase the risk of incarceration or strangulation with the need for urgent surgery. We report a patient who presents adenocarcinoma of the sigmoid colon lodged in a giant inguino-scrotal hernia.

BACKGROUND: Amyand\'s hernia (AH) is an appendix (with or without acute inflammation) trapped within an inguinal hernia. Most AH with acute appendicitis had a preexisting appendix within the hernia sac. We herein report a variant of AH that has never been described before. An inflamed appendix that was managed conservatively was found to have migrated and trapped in the sac of a previously unrecognized right inguinal hernia 6 weeks after the index admission, resulting in a secondary Amyand\'s hernia.
METHODS: A 25-year-old healthy Taiwanese woman had persistent right lower abdominal pain for 1 week and was diagnosed with perforated appendicitis with a localized abscess by abdominal computed tomography (CT). No inguinal hernia was noted at that time. Although the inflamed appendix along with the abscess was deeply surrounded by bowel loops so that percutaneous drainage was not feasible, it was treated successfully with antibiotics. However, she was rehospitalized 6 weeks later for having a painful right inguinal bulging mass for a week. Abdominal CT revealed an inflamed appendix with abscess formation in an indirect inguinal hernia raising the question of a Amyand\'s hernia with a perforated appendicitis. Via a typical inguinal herniorrhaphy incision, surgical exploration confirmed the diagnosis, and it was managed by opening the hernial sac to drain the abscess and reducing the appendix into the peritoneal cavity, followed by conventional tissue-based herniorrhaphy and a laparoscopic appendectomy. She was then discharged uneventfully and remained well for 11 months.
CONCLUSIONS: Unlike the traditional definition of Amyand\'s hernia, where the appendix is initially in the hernia sac, the current case demonstrated that Amyand\'s hernia could be a type of delayed presentation following initial medical treatment of acute appendicitis. However, it can still be managed successfully by a conventional tissue-based herniorrhaphy followed by laparoscopic appendectomy.

BACKGROUND: Incarceration occurred in approximately 5% to 15% of inguinal hernia patients, with around 15% of incarcerated cases progressing to intestinal necrosis, necessitating bowel resection surgery. Patients with intestinal necrosis had significantly higher mortality and complication rates compared to those without necrosis.The primary objective of this study was to design and validate a diagnostic model capable of predicting intestinal necrosis in patients with incarcerated groin hernias.
METHODS: We screened the clinical records of patients who underwent emergency surgery for incarcerated inguinal hernia between January 1, 2015, and December 31, 2022. To ensure balanced representation, the enrolled patients were randomly divided into a training set (n = 180) and a validation set (n = 76) using a 2:1 ratio. Logistic regression analysis was conducted using the rms package in R software, incorporating selected features from the LASSO regression model, to construct a predictive model.
RESULTS: Based on the results of the LASSO regression analysis, a multivariate logistic regression model was developed to establish the predictive model. The predictors included in the model were Abdominal effusion, Hernia Sac Effusion, and Procalcitonin. The area under the receiver operating characteristic (ROC) curve for the nomogram graph in the training set was 0.977 (95% CI = 0.957-0.992). In the validation set, the AUC for the nomogram graph was 0.970. Calibration curve and decision curve analysis (DCA) verified the accuracy and practicability of the nomogram graph in our study.
CONCLUSIONS: Bowel necrosis in patients with incarcerated inguinal hernia was influenced by multiple factors. The nomogram predictive model constructed in this study could be utilized to predict and differentiate whether incarcerated inguinal hernia patients were at risk of developing bowel necrosis.

BACKGROUND: In pediatric patients, incarcerated inguinal hernias are often repaired on presentation. We hypothesize that in appropriate patients, repair may be safely deferred.
METHODS: The Nationwide Readmissions Database was used to identify pediatric patients (aged < 18 y) with incarcerated inguinal hernia from 2010 to 2014. Patients were stratified by management approach (Early Repair versus Deferral). Overall frequencies of these operative strategies were calculated. Propensity score matching was then performed to control for patient age, comorbidities, perinatal conditions, and congenital anomalies. Outcomes including complications, surgical procedures, and readmissions were compared. Outpatient surgeries were not assessed.
RESULTS: Among 6148 total patients with incarcerated inguinal hernia, the most common strategy was to perform Early Repair (88% versus 12% Deferral). Following propensity score matching, the cohort included 1288 patients (86% male, average age 1.7 ± 4.1 years). Deferral was associated with equivalent rates of readmission within one year (13% versus 15%, P = 0.143), but higher readmissions within the first 30 days (7% versus 3%, P = 0.002) than Early Repair. Deferral patients had lower rates of orchiectomy (2% versus 5%, P = 0.001), wound infections (< 2% versus 2%, P = 0.020), and other infections (7% versus 15%, P < 0.001). The frequency of other complications including bowel resection, oophorectomy, testicular atrophy, sepsis, and pneumonia were equivalent between groups. Three percent of Deferrals had a diagnosis of incarceration on readmission.
CONCLUSIONS: Deferral of incarcerated inguinal hernia repair at index admission is associated with higher rates of hospital readmissions within the first 30 days but equivalent readmission within the entire calendar year. These patients are at risk of repeat incarceration but have significantly lower rates of orchiectomy than their counterparts who undergo inguinal hernia repair at the index admission. We propose that prospective studies be performed to identify good candidates for Elective Deferral following manual reduction and overnight observation. Such studies must capture outpatient surgical outcomes.

BACKGROUND: Vasitis is a rare condition that may be challenging for the clinical practitioner. Sometimes it is misdiagnosed as incarcerated inguinal hernia; thus, patients end up receiving unnecessary surgery. Compared with the traditional approach with only sonography, the more recent introduction of computed tomography in the diagnostic process has provided higher quality imaging and more detailed anatomy. Consequently, some urologists advocate the efficacy of computed tomography in the differential diagnosis of difficult cases.
METHODS: We present the case of a 23-year-old male who suffered from right inguinal pain and swelling. His scrotum ultrasound showed multiple tubular structure dilatation within the subinguinal area and no testis torsion. The initial diagnosis was a right inguinal hernia. Computed tomography supported that initial diagnosis, and we presumed the lesion represented a herniation of the omentum with mesenteric vessels. Since there was a suspicion of hernia incarceration, the patient underwent diagnostic laparoscopy, which did not reveal herniation, but only erythematous reaction and swelling over the right spermatic cord. Following a final diagnosis of vasitis, he received empirical antibiotic treatment and his symptoms entirely resolved.
CONCLUSIONS: Even though computed tomography can provide thorough imaging of the urogenital system, the contrast enhancement within vessels and inflammatory organs can still be misleading in the diagnostic process.
RéSUMé: CONTEXTE: La déférendite est. une maladie rare qui peut présenter des difficultés pour le praticien. Parfois, elle est. diagnostiquée à tort comme une hernie inguinale incarcérée; ce qui amène les patients à subir une intervention chirurgicale inutile. Par rapport à l’approche traditionnelle avec la seule échographie, l’introduction plus récente de la tomodensitométrie dans le processus diagnostique a fourni une imagerie de meilleure qualité et une anatomie plus détaillée. Par conséquent, certains urologues préconisent l’efficacité de la tomodensitométrie dans le diagnostic différentiel des cas difficiles. PRéSENTATION DU CAS: Nous rapportons le cas d’un homme de 23 ans qui souffrait d’une douleur et d’une tuméfaction inguinales droites. L’échographie du scrotum a montré une dilatation de multiples structures tubulaires dans la région subinguinale, sans torsion du testicule. Le diagnostic initial a été une hernie inguinale droite. La tomodensitométrie a confirmé ce diagnostic initial, et nous avons supposé que la lésion représentait une hernie de l’épiploon avec des vaisseaux mésentériques. Comme il y avait une suspicion d’incarcération de hernie, le patient a subi une laparoscopie diagnostique, qui n’a pas révélé de hernie, mais seulement une réaction érythémateuse et un gonflement du cordon spermatique droit. Après un diagnostic final de déférendite, le patient a reçu un traitement antibiotique empirique et ses symptômes ont été entièrement résolus. CONCLUSIONS: Même si la tomodensitométrie peut fournir une imagerie approfondie du système urogénital, l’amélioration du contraste dans les vaisseaux et les organes inflammatoires peut encore être trompeuse dans le processus diagnostique. MOTS-CLéS: Déférendite hernie inguinale incarcérée tomodensitométrie laparoscopie diagnostique.

UNASSIGNED: An inguinal hernia is a common surgical disease. Once incarcerated or strangulated, it may endanger the life of the patient. Therefore, it is essential to study the risk factors of incarcerated inguinal hernia (IIH) and strangulated inguinal hernia (SIH). One of the serious complications of IIH and SIH is intestinal necrosis, which occurs owing to blood supply disorder. The study explores the risk factors of intestinal resection and establishes a simple model to assess the incidence of intestinal resection to provide significant assistance and limited guidance for clinical work.
UNASSIGNED: Our research team collected and retrospectively analysed the clinical data of 338 patients with IIH who were hospitalized in the First Affiliated Hospital of Wenzhou Medical University between September 2008 and December 2016. According to the surgical plan, we divided the included cases into two groups, non-intestinal and intestinal resection groups, and the clinical case characteristics of these groups were statistically analysed.
UNASSIGNED: Based on multivariable logistic regression analysis, we found that increased risk of bowel resection was highly correlated among the elderly (≥70 years), and for people with high temperature (≥37.3°C), high systemic immune-inflammation index(SII) values (≥1230.13), presence of bowel obstruction, and signs of peritonitis. Further, we processed the five independent risk factors using special software to obtain a simple model called a nomogram. To verify the nomogram\'s accuracy and predictive ability, we calculate the C-index: 0.806 and use the calibration curve to evaluate its stability and predictive performance. We constructed the ROC curve nomogram and other sub-variables, and calculated the area under the curve (AUC) corresponding to the nomogram (AUC = 0.808, 95% CI = 0.762 to 0.848), SII (AUC = 0.752, 95% CI = 0.703 to 0.797), age (AUC = 0.641, 95% CI = 0.587 to 0.692), temperature (AUC = 0.579, 95% CI = 0.524 to 0.632), bowel obstruction (AUC = 0.685, 95% CI = 0.633 to 0.734), and signs of peritonitis (AUC = 0.580, 95% CI = 0.525 to 0.633).
UNASSIGNED: It can be said that we found for the first time that clinical variables such as SII are independent risk factors for enterectomy for IIH. The nomogram based on SII and other variables can accurately and easily predict the probability of IIH requiring bowel resection.

BACKGROUND: Incarcerated inguinal hernia is an irreducible but the blood supply to the contained part is intact, but developing towards strangulation. Diagnosis usually made by physical examination. The content of hernia sac may vary. The usual finding is a segment of small intestine and less commonly large intestine. Except in sliding hernia, the sigmoid colon is not common in inguinal hernia, especially on the right side.
METHODS: We report a rare case of an incarcerated right side inguinal hernia containing the sigmoid colon of a 65-year old male, diagnosed with physical examination and abdominal ultrasonography. This patient treated by reducing the content of hernia sac and herniorraphy in general surgery ward of Aliabad Teaching Hospital.
CONCLUSIONS: Inguinal hernia is the commonest of all groin hernia. Incarcerated inguinal hernia can lead to intestinal obstruction, strangulation and infarction. The content of inguinal hernia varies widely. In our case, the content of hernia sac was the incarcerated loop of sigmoid colon. The sigmoid colon is commonly found to herniate at the left inguinal region, but as a content of a right side inguinal hernia is rare.
CONCLUSIONS: The sigmoid colon as a content of a right side inguinal hernia is rare. Mesh repair has always been a subject of debate due to increased risk of mesh infection rates. Many patients present complications due to delayed elective repair of inguinal hernia.

UNASSIGNED: An inguinal hernia may transform to an incarcerated hernia, which would require emergency surgery with increased morbidity and mortality. This study aims to analyze whether it is possible to predict intestinal ischemia in incarcerated hernia using complete blood count parameters and serum C-reactive protein (CRP).
UNASSIGNED: Medical records of 129 patients were used to analyze whether there is a correlation between intestinal ischemia and laboratory parameters. Receiver operating characteristics analysis and Youden index were used to determine cutoff values, sensitivity, and specificity.
UNASSIGNED: Female patients, those with a femoral type hernia, and patients with additional diseases were found to be more prone to bowel resection. CRP, lymphocyte to CRP ratio (LCR), and neutrophil to CRP ratio (NCR) parameters were significant (AUC=0.914, p<0.001; AUC=0.901, p<0.001; and AUC=0.908, p<0.001, respectively). A value <0.45 for NCR has a sensitivity of 93.3% and specificity of 87.8%; a value >19 in CRP has a 90% sensitivity and 88.9% specificity.
UNASSIGNED: Decreased pre-operative NCR and LCR, and increased CRP levels can be used as a predictor for estimating intestinal ischemia.