Spontaneous scrotal faecal fistula in a neonate: report of a case (original) (raw)
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Neonatal perforated Amyand's hernia presenting as an enterocutaneous scrotal fistula
Asian Journal of Surgery, 2014
Perforation of the vermiform appendix in a septic neonate with an Amyand's hernia resulted in the formation of a scrotal enterocutaneous fistula. In conclusion from this exceptional complication, active parental awareness for any neonatal scrotal swelling is required, and an early operative policy for the neonatal inguinal hernia is significant.
CASE REPORT Enterocutaneous Fistula of the Scrotum
Inguino-scrotal hernia is a very common surgical entity. Though much common in pediatric population, yet no age is exempted. The diagnosis and management is also prompt in expert surgical hands. The incarceration of inguinal hernia in children varies between 5 to 23.6% in many series and is more frequent in neonates and infants. Incarceration and strangulation is more common in developing countries probably due to not so good health care infrastructure and health education amongst the comparatively less educated population (1,2,3,4).The scrotal enterocutaneous fistula following incarceration/ strangulation of inguino-scrotal hernia is beyond doubt the very rare complication even in the developing world. (5,6).Due to rarity of this surgical entity we present here two very rare case of scrotal enterocutaneous fistula one following intervention by a surgeon misdiagnosing strangulated inguinoscrotal hernia in a 65 years old male and another 40 years male from very low socio-economic Abstract Inguino-scrotal hernia is a very common surgical entity. Though much common in pediatric population, yet no age is exempted. Enterocutaneous fistula in an inguino-scrotal hernia is a very rare surgical entity in both developing as well as developed countries. Comparatively commoner in pediatric age group but no age is exempt, the information gathered from few cases available in the surgical literature. About 08 cases in pediatric age group and 06 cases in adult population are available in the literature that could be revealed from Pubmed/Medline as well as medical library shelf search. We report here two rare cases of scrotal enterocutaneous fistula in an adult in inguinoscrotal hernia.
Scrotal Enterocutaneous Fistula: A dilemma of Long-Standing untreated Inguinal Hernia
2020
In surgical practice inguinal hernias are a common patient presentation. Though access to surgical intervention for inguinal hernia is readily available in hospitals, lack of awareness and patient negligence leads to not seeking prompt treatment until severe symptoms appear. This is a description of a case of a 70-year-old man with long standing inguinal hernia since the past 10 years with no history of previous clinical management. The patient presented with an entero-scrotal fistula which occurred spontaneously and sought medical opinion after 6 months of developing it, when repeated faecal discharge began. This is a rare complication of underlying inguinoscrotal swelling which has been long-standing in nature. An exploratory laparotomy was performed on this patient with resection of the perforated small bowel. Purse-string suture was taken at the deep inguinal ring and end-to-end anastomosis of the ileal segment was done. There were no post-operative complications and the patient...
A Study of Inguinal Hernia in Infants and Children
Annals of International medical and Dental Research, 2016
Background: Inguino-scrotal swellings are frequently observed in patients of pediatric age group. Inguinal hernia and Hydrocele are the most common causes of such swellings in children. For their effective management, it is essential to study various factors like age, sex etc. associated with inguinal hernia in pediatric age group. Objectives: To study the epidemiology, management and outcome of inguinal hernia in children. Methods: A prospective study was conducted on pediatric patients with inguinal hernia for a period of 18 months, between February 2015 to July 2016. Patients from newborn to 14 years of age were selected for this study. Results: Inguinal hernia can occur at any age, but the majority of patients are seen between 1 to 5 years of age. It is more commonly seen in male children and incidence is slightly higher on right side. Almost all of the inguinal hernia in pediatric age group is of indirect type, which develops due to congenitally patent processus vaginalis. Conclusion: Early surgical intervention in form of Inguinal herniotomy is the most appropriate management of inguinal hernia in children.
Background:Inguinal hernia repair is one of the most common pediatric operations performed nowadays. Majority are right sided indirect hernias and common in male gender. 1,2 Presentation varies from asymptomatic to life threatening complications. Operations are usually done under general anesthesia in an elective setting but the acute presentations like obstruction or strangulation are managed in emergency. Objectives:To see the clinical presentation and management outcome of congenital inguinal hernia cases who presented in the Pediatric Surgery Department of Qurrayatcentral hospital, Northern province, Kingdom of Saudi Arabia. Subjects and Methods: 4 years descriptive study of pediatric patients with inguinal hernia in Central hospital of Qurrayat city, Kingdom of Saudi Arabia, excluding patients with comorbidities or congenital malformations. Data included age, gender, clinical presentation, involvement (unilateral or bilateral), content of the sac, associated conditions, operative choice (elective or emergency) and complications after operation. Data analysis was done using statistical package SPSS version 16. Results: In 4 years, 520 patients (Male to female ratio 7:1) presented with inguinal hernia, majority less than 1 year (55%) with right sided predominance (56.5%). Undescended testis in 12(2.4%) and hydrocele in 9(1.8%) were the associated conditions. Some cases presented with contents like large intestine (5.2%), appendix (0.8%), testis (0.6%) and small intestine or ovary (0.4%) while 11.3% came in emergency as strangulated hernias. After operation, nearly all cases (98.5%) passed without complications, recurrence occurred in 6(1.2%) cases and 2(0.4%) cases were complicated by wound infection, seen in older aged patients. Sac containing large intestine or appendix presented with complications. Conclusion: In this study the trend of presentation was more in children less than a year in age, with male predominance, and in most cases right side was involved, complications were less frequent but seen in older children, in emergency cases and when the sac contents were large intestine or appendix.
ABC of General Paediatric Surgery: INGUINAL HERNIA, HYDROCELE, AND THE UNDESCENDED TESTIS
BMJ, 1996
Clinical embryology and anatomy of the inguinal region dutomna '~The testis is formed from coelomic epithelium and primordial germ cells in a longitudinal fold high on the posterior abdominal wall at a similar level to the developing kidneys. As gestation proceeds, the testis migrates down the posterior wall towards the deep inguinal ring, probably under the control of the hormone mullerian duct inhibitory factor. The gubernaculum, a condensation of mesenchyme, forms _ within the future inguinal canal and guides the testis through the layers i_______ of the body wall towards the scrotum. Two factors seem to be important in this second stage-the release of testosterone from the fetal testis itself and an intact genitofemoral nerve, which probably-\ l <; releases substances causing gubernacular contraction. A tongue of the peritoneal cavity also precedes the migrating testis through the canal-the processus vaginalis. After birth this peritoneal communication should obliterate and disappear, but failure to do this may lead to two of the commonest problems of this region, hernias and .....%'..%-. hydroceles. Anatomy of the processus vaginalis. Inguinal hernias Anatomically these are virtually all indirect and often complete (that is, the sac comes all the way to the scrotum). Infantile hernias occur in about 1-2% of births and are much more common in premature babies than in full term infants. They appear as an intermittent, usually reducible, lump in the groin. The correct management is a surgical herniotomy when the child's condition allows. In most uncomplicated cases this should be within two or three weeks of diagnosis. Infant
Amyand’s Hernia Presenting as a Scrotal Abscess – A Rare Presentation in a Newborn
Surgical Case Reports, 2021
A 26-week-old extreme preterm boy presented with a right hemiscrotal abscess. An ultrasound of the scrotum suggested right epididymo-orchitis. The abscess was drained and appropriate intravenous antibiotics were initiated. One month later, he was diagnosed with a right sided irreducible inguino-scrotal swelling, confirmed as bilateral inguinal hernia with herniating bowel loop on ultrasonography. With this diagnosis, he was planned to undergo a bilateral herniotomy. Intraoperatively, an inflamed and perforated appendix was found herniating into the right sac. The tip of the appendix was adherent to the scrotal wall, where the pus was extruding out. Appendicectomy and bilateral herniotomy was done successfully and histopathology revealed acute appendicitis. Baby recovered well postoperatively. Owing to the fragile nature of tissues in neonates, accession of planes was challenging. Amyand’s hernia presenting as a scrotal abscess is extremely rare in newborn infants, and less than 5 ca...
Prenatal Presentation of Inguinoscrotal Hernia
Journal of Diagnostic Medical Sonography, 2010
Prenatal diagnosis of inguinal hernia is rare and easily confused with other entities, including masses of the scrotum, abdominal wall, and perineum. Pathologic processes of the scrotum rarely result in enlargement beyond 7 cm. Peristalsis can help to indentify bowel within the mass, suggestive of hernia or omphalocele rather than hydroceles or tumors that contain no bowel. Torsions have a double-ring appearance with no testicular blood flow, whereas hydroceles have visible testicles within a fluid-filled scrotum. Doppler evaluation may be helpful, as hernias typically have minimal vascularity, unlike tumors and teratomas, which are vascular with a widely variable appearance. The authors present the sonographic features of a late-presenting fetal mass that was clinically indistinguishable from omphalocele other than its skin thickness and was larger than typically reported for hernias. Skin thickness and subcapsular fluid are useful adjuncts in distinguishing inguinoscrotal hernia from omphalocele in late gestation.