The processus vaginalis within the inguinal canal forms the canal of Nuck, which is a homolog of the processus vaginalis in women. Incomplete obliteration of the processus vaginalis causes indirect inguinal hernia or hydrocele of the canal of Nuck, a very rare condition in women. Here, we report 2 cases of hydrocele of the canal of Nuck that were diagnosed with ultrasonography in both cases and magnetic resonance imaging in 1 case to confirm the sonographic diagnosis. High ligation and hydrocelectomy were conducted in both patients. In 1 patient, 14 months later, the occurrence of contralateral inguinal hernia was suspected, but did not require surgery. The other patient had a history of surgery for left inguinal hernia 11 months before the occurrence of right hydrocele of the canal of Nuck. In both cases, the occurrence of an inguinal hernia on the contralateral side was noted.
Female ; Hernia, Inguinal ; Humans ; Inguinal Canal ; Ligation ; Magnetic Resonance Imaging

BACKGROUND: It has been reported that bilateral pediatric inguinal hernias (PIH) are around 10% and that a late contralateral herniorrhapy is needed in up to 34% of ipsilateral operations. However, clinical prediction of the contralateral patent processus vaginalis (PPV) is difficult. The aims of this study were to measure the mean diameter of the internal inguinal ring (IIR) of the PIH at rest and during straining and to define the diagnostic criterion for positive contralateral PIH (or PPV) by using ultrasonography (USG). METHODS: The diameters of both ipsilateral and contralateral IIRs at rest and during straining were measured preoperatively by USG in 104 consecutive pediatric patients (75 male, 29 female; mean age of 3 years) who had undergone an ipsilateral herniorrhaphy with contralateral exploration from March 1997 to December 1997. Fifty-seven right inguinal hernias (RIH), 43 left inguinal hernias (LIH), and 4 bilateral inguinal hernias were enrolled. The contralateral PPV was defined as a sac greater than 3 mm in diameter and longer than 2 cm in length measured intraoperatively. Statistical analysis was performed by using the t-test and the chi-square test. RESULTS: Contralateral exploration showed positive PPV in 44% of RIH and 47% of LIH (p>0.05). In RIH, the mean diameter of right IIR (RIIR) was wider than that of left IIR (LIIR) (5.02+/-0.27 mm vs 2.94+/-0.12 mm at rest and 7.50+/-0.52 mm vs. 3.82+/-0.23 mm during straining, p<0.01), and the difference in diameters between straining and rest were also significant (2.38+/-0.37 mm in RIIR and 0.76+/-0.14 mm in LIIR, p<0.01). In LIH, the mean diameter of LIIR was wider than that of RIIR (4.59+/-0.27 mm vs. 3.13+/-0.19 mm at rest, 6.82+/-0.43 mm vs. 3.61+/-0.26 mm during straining, p<0.01). The diameter difference between straining and rest of LIIR and RIIR were also significant (2.17+/-0.28 mm in LIIR, 0.60+/-0.12 mm in RIIR, p<0.01). Cases of positive contralateral PPVs in RIH had significantly wider LIIRs than those of negative PPV (3.5+/-0.16 mm vs. 2.5+/-0.14 mm at rest and 4.70+/-0.32 mm vs. 2.97+/-0.20 mm during straining, p<0.01). The difference of diameter between strainingand rest of positive and negative PPVs were significant (1.16+/-0.25 mm and 0.38+/-0.09 mm, respectively, p<0.01). Cases of positive contralateral PPVs in LIH had wider RIIRs than those of negative PPV significantly (3.83+/-0.27 mm vs. 2.52+/-0.18 mm at rest and 4.58+/-0.38 mm vs. 2.68+/-0.19 mm during straining, p<0.01). The diameter difference between straining and rest of positive and negative PPVs was significant (0.93+/-0.21 mm and 0.3+/- 0.09 mm, respectively, p<0.05). CONCLUSION: In most negative PPVs, the diameter of the IIR did not exceed 3.0 mm. Therefore, contralateral IIR with diameters wider than 3.0 mm and diameters of difference more than 1.0 mm between straining and rest, as determined by using USG need to be explored.
Female ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Inguinal Canal* ; Male ; Ultrasonography

Transverse testicular ectopia is a rare anomaly in which both testes descend through one inguinal canal and are in the same side of the scrotum. A case report of transverse testicular ectopia with incomplete regression of Mullerian duct in a 11 months old boy is detailed with a brief review of literature.
Humans ; Infant ; Inguinal Canal ; Male ; Scrotum ; Testis

Laparoscopy was performed successfully at operation in 18 consecutive boys who had 19 nonpalpable testes Of the testes. 2 were in the inguinal region. 6 were in the just proximal to the internal inguinal ring. 2 were high intra-abominal position. and 9 were vanished testes (intracana1icular). In every case of vanished inguinal testis and intracanalicular testis. vas and gonadal vessels were observed laparoscopically to exit the internal inguinal ring. In these vanished testes. hernia or patent processus vaginalis was not observed and contralateral testes were located normally in the scrotum. OF 8 intraabdominal testes. 6 were detected laparoscopically. Laparoscopy provided localization or either testis or the course of spermatic vessels in all patients and these information facilitated accurate planning of operative repair.
Gonads ; Hernia ; Humans ; Inguinal Canal ; Laparoscopy* ; Scrotum ; Testis*

Ectopic scrotum is extremely rare and refers to the anomalous position of one hemiscrotum along the inguinal canal. Only two cases of ectopic scrotum have been reported in Korea. We experienced a case of unilateral ectopic scrotum with crytorchidism. The penis showed normal in appearence. The ectopic scrotum with cryptorchidism was found on the left inguinal area. And there was left ipsilateral renal agenesis on the ultrasonogram and DMSA renal scanning. We successfully performed scrotoplasty and orchiopexy.
Cryptorchidism* ; Inguinal Canal ; Korea ; Male ; Orchiopexy ; Penis ; Scrotum* ; Succimer ; Ultrasonography

Herniation of the appendix into an inguinal canal is known as an Amyand hernia. Due to its nonspecific symptoms, clinical diagnosis is extremely difficult, and an accurate preoperative diagnosis of Amyand hernia with ultrasound (US) and CT is rarely reported. Herein, we reported a typical case of Amyand hernia in a 74-year-old male in which the correct diagnosis was made using inguinal US and contrast-enhanced abdominopelvic CT. US and CT findings of Amyand hernia showed a target-like tubular structure within the inguinal canal.
Aged ; Appendix ; Diagnosis ; Hernia* ; Humans ; Inguinal Canal ; Male ; Ultrasonography*

Between March 1999 and January 2000, 82 boys with the diagnosis of inguinal hernias (12 bilateral and 70 unilateral hernias), underwent Ultrasound (US) examination of both sides of the groin, a total of 164 inguinal imaging prior to surgery. The patients ages ranged from 3 days to 12 years with a mean of 32.6 months. Ninty four examinations were on the clinically symptomatic side and 70 were on the asymptomatic side. The US criteria for the diagnosis of an inguinal hernia were as follows: 1) visceral hernia, the presence of bowel loops, or omentum in the inguinal canal, 2) communicating hydrocele, the presence of fluid in the processus vaginalis, 3) widening of patent processus vaginalis at the level of nternal inguinal ring. The width of patent processus vaginalis at the level of internal inguinal ring over 4 mm is onsidered an occult hernia. Among the 94 symptomatic groins, US findings showed 31 (33 %) visceral hernias, 18 (19 %) communicating hydroceles, and 38 (41 %) widening of the internal inguinal ring, and 7 (7 %) groins without abnormalities. In 70 asymptomatic groins, there were 4 (6 %) visceral hernias, 5 (7 %) communicating hydroceles, 11 (16 %) widening of the internal inguinal ring, and 50 (70 %) groins without abnormalities. Among the 70 asymptomatic groins there were US abnormalities in 20 (28 %). One hundred and seven groins with positive US findings were surgically explored. Among 107 operated sites, the operative findings were compatible with the US diagnosis in 104, a sensitivity for US of 97.2 %. In patients with US findings of widening of internal inguinal ring (>4 mm), there was patent processus vaginalis in 36 out of 38 symptomatic groins and 10 of 11 asymptomatic groins. The sensitivity of US to the operative findings in widening of internal inguinal ring was 93.8 %. For visceral hernia and communicating hydrocele, the sensitivity of positive US findings was 100 %. Ultrasonography for inguinal hernias appears to be a rapid, reliable, and noninvasive screening diagnostic tool with high positive specificity. Therefore, we recommend the use of US as a routine diagnostic tool in pediatric patients with inguinal hernias and hydroceles.
Diagnosis ; Groin ; Hernia ; Hernia, Inguinal* ; Humans ; Inguinal Canal ; Mass Screening ; Omentum ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: Laparoscopy through the open ipsilateral hernial sac to evaluate the contralateral side in boys with unilateral inguinal hernia has been criticized because of some risk and cost. Laparoscopic evaluation of the contralateral side was modified to avoid abdominal trocar insertion by using the open ipsilateral hernia sac for instrumentation. This study was performed to determine the usability, safety, and effectiveness of this technique. MATERIALS AND METHODS: Forty-two boys with unilateral inguinal hernia and hydrocele were evaluated using open hernial sac for diagnostic laparoscopy of the contralateral side at the time of inguinal herniorrhaphy. RESULTS: The mean age was 3.8 years. The presenting hernia was right-sided in 29 (69.0%) cases and left-sided in 13 (31.0%) cases. Based on the result of diagnostic laparoscopy 32 (76.2%) cases were negative on the contralateral side, and 10 (23.8%) were positive. After the contralateral exploration of the positive groups, 9 (90.0%) showed contralateral patent processus vaginalis. After undergone the high ligation of the patent processus vaginalis at the internal inguinal ring. CONCLUSIONS: Laparoscopic evaluation of the contralateral side via the open ipsilateral hernial sac is feasible, quick, safe, and cost effective. It requires no additional incision. Long-term follow up is required to determine the ultimate effectiveness of this method.
Child* ; Follow-Up Studies ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Inguinal Canal ; Laparoscopy* ; Ligation ; Surgical Instruments

The development of Morgagni hernias is related to malformations of the embryologic septum transversum after failure of the sternal and costal fibrotendinous elements of the diaphragm to fuse. The overall incidence of Morgagni hernias among all congenital diaphragmatic defects is 3% to 4%. Inguinal hernias are the most common hernias in males and females (25% and 2%, respectively). An inguinal hernia is defined as a protrusion of the abdominal cavity contents through the inguinal canal. The combination of Morgagni and inguinal hernias is rare, and treatment using laparoscopic surgery has not been previously reported. This case presents a one-stage laparoscopic repair of Morgagni and inguinal hernias in a 2-month-old male.
Abdominal Cavity ; Diaphragm ; Female ; Hernia ; Hernia, Inguinal ; Humans ; Incidence ; Infant ; Inguinal Canal ; Laparoscopy ; Male

An inguinal hernia is common in pediatric age. However, an in injury to the bladder during hernia repair is quite rare, which may be related to the lack of awareness of the inguinal canal anatomy or inadequate exposure. Gross hematuria and voiding difficulty after herniorrhaphy may indicate a possible injury. Cystography can define the presence and type of injury. An extraperitoneal bladder injury can be managed safely by catheter drainage, antibiotics, and close clinical observations. An intraperitoneal injury requires surgical exploration and bladder closure. We report a case of a urinary bladder injury that was detected after the completion of herniorrhaphy in an eight-year-old girl.
Anti-Bacterial Agents ; Catheters ; Drainage ; Female ; Hematuria ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Inguinal Canal ; Urinary Bladder*