Right Open Indirect Inguinal Hernia Repair and Radical Inguinal Orchiectomy
An inguinal hernia is a condition where intra-abdominal organs bulge through the abdominal muscles or the inguinal canal. It is more common in males than in females and can occur at any age. Most adult inguinal hernias are considered acquired defects caused by weakness in the abdominal wall musculature due to excessive straining from heavy lifting, weight gain, coughing, or difficulty with bowel movements and urination. Inguinal hernias present as a bulge in the groin area that can become more prominent when coughing, straining, or standing up, and disappears when lying down. Symptoms are present in around 66% of affected people which may include pain or discomfort especially with coughing, exercise, or bowel movements. Medical history and physical examination are key to diagnosing inguinal hernias; however, imaging tests such as ultrasound, CT scan, or MRI can aid in the diagnosis when findings are equivocal. Inguinal hernias are generally classified as indirect, direct, or femoral based on the site of herniation relative to surrounding structures. In adults, watchful waiting is usually recommended for small and reducible inguinal hernias; however, inguinal hernias that enlarge, cause symptoms, or become incarcerated or strangulated are treated surgically. Surgical treatment can be divided into tissue repair and mesh repair with the latter being preferred due to having a lower recurrence rate.
An undescended testicle is a testicle that never moved to its proper position in the scrotum. The majority of these cases involves only one testicle, but around 10% can involve both. Complications involved with this condition include testicular cancer and infertility, and surgical correction is recommended before the child reaches 18 months old.
Here, we present a 78-year-old male who was diagnosed with a right inguinal hernia. Upon exploration, the right testicle was noted to be undescended and involved with the hernial sac. Based on the patient's age, and the risk for future malignancy, the hernia repair also included an orchiectomy.
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