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.

Inguinal hernias are among the most common cases presented to a surgeon. In spite of extensive research and clinical experience over centuries, inguinal hernias still pose anatomical challenges for operating surgeons, especially with a propensity for recurrence. One such complicated entity is the Amyand\'s hernia - defined as an inguinal hernia contained within the hernial sac - the vermiform appendix - as the herniated content. It is a rare clinical presentation and carries with it certain complexities with regard to operative decisions and clinical management. We present a case of a 71-year-old male presenting with a recurrent inguinal hernia, with an incarcerated, inflamed appendix as the content; managed surgically with appendicectomy and herniorraphy, without the use of a prosthetic mesh.

UNASSIGNED: Hernias are one of the commonest procedures performed by general surgeons. Irreducibility, intestinal obstruction, and strangulation are common outcomes of a groin hernia when there is disregard and a delay in elective surgery. Studies have shown a considerable incidence of these hernia complications, along with the associated morbidity and death, because of delayed presentation. Testicular gangrene following incarcerated hernias is a rare entity in the adult population.
METHODS: Here we present a case of a 30-year-old male presented with gangrenous vanished testis, perforated ileum and necrotizing fasciitis of the right groin after a neglected strangulated right inguinal hernia.
UNASSIGNED: Testicular infarction/gangrene is most commonly secondary to testicular torsion, an emergency that teenagers frequently experience. When it complicates inguinal hernia, it typically results in ischemia, infarction, and gangrene due to compression and impairment of the vascular supply within the inguinal canal. In cases like our where there is a necrotizing process in the groin, we feel it\'s appropriate to approach from the abdomen and do the resection first and proceed with the radical debridement after that.
CONCLUSIONS: Early diagnosis and intervention with emergency surgery are crucial for strangulated inguinal hernia and prevents unnecessary escalation of the problem with progressive infectious and necrotic destruction of adjacent tissues.

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.

Inflammation of the vas deferens or what known as acute vasitis is an under-reported condition that usually presents with scrotal or inguinal pain and swelling which can be misdiagnosed and treated as many other conditions. Here, we present one of the first cases to be reported in the literature with bilateral manifestation. A 28-year-old male patient presented complaining of bilateral testicular and inguinal pain associated with inguinal swelling for 3 days. Initially, the patient was being evaluated as a case of incarcerated bilateral inguinal hernia, but with the aid of radiological imaging, the patient was diagnosed correctly and the unnecessary surgical intervention was prevented.

Postoperative ileus (POI) occurs after gastrointestinal and other intra-abdominal surgeries, and its incidence rate is reported to range between 10 and 30% following major abdominal surgery. Should ileus remain for several days or if symptoms worsen despite management, further investigation is warranted to consider other diagnoses such as small bowel obstruction (SBO), intra-abdominal abscess, or perforation. The etiology of postoperative obstructive symptoms can evolve during the postoperative course and many possible factors contribute to postoperative gastrointestinal dysfunction. Prolonged POI may be a risk factor for hernia incarceration. We describe the case of a 72-year-old male with a history of perforated diverticulitis and Hartmann procedure status post-colostomy takedown complicated by prolonged POI for six days. Clinical workup revealed incarcerated inguinal hernia, which was treated with urgent inguinal hernia repair. Follow-up revealed resolution of gastrointestinal dysfunction within 48 hours of hernia repair.

The inflatable penile prosthesis (IPP) is a three-piece device indicated to treat erectile dysfunction. Although it is considered a safe procedure, it can result in complications, such as reservoir herniation. Literature is scarce regarding reservoir incarcerated herniation as a complication of IPP and its management. Surgery is required to reduce symptomatic hernias and properly secure the reservoir to avoid recurrence. An untreated incarcerated hernia may lead to strangulation and necrosis of abdominal organs, as well as implant malfunction. We present a rare case of a left-sided incarcerated inguinal hernia containing fat and a penile reservoir of a previous penile prosthesis implant in a 79-year-old man, as well as the technique used to correct it.