Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2021; 9(2): 509-515
Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.509
Indirect inguinal hernia containing portosystemic shunt vessel: A case report
Masahiro Yura, Kikuo Yo, Asuka Hara, Keita Hayashi, Yuki Tajima, Yasushi Kaneko, Hiroto Fujisaki, Akira Hirata, Kiminori Takano, Kumiko Hongo, Kimiyasu Yoneyama, Motohito Nakagawa
Masahiro Yura, Kikuo Yo, Asuka Hara, Keita Hayashi, Yuki Tajima, Yasushi Kaneko, Hiroto Fujisaki, Akira Hirata, Kiminori Takano, Kumiko Hongo, Kimiyasu Yoneyama, Motohito Nakagawa, Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
Author contributions: Yura M and Yo K performed surgery and wrote this paper; Nakagawa M reviewed the manuscript; all other members equally contributed to medical treatment; and all authors were responsible for the revision of the manuscript and final approval for submission.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masahiro Yura, MD, Doctor, Surgeon, Department of Surgery, Hiratsuka City Hospital, 1-19-1, Minamihara, Hiratsuka 2540065, Kanagawa, Japan. myura@ncc.go.jp
Received: October 3, 2020
Peer-review started: October 3, 2020
First decision: November 3, 2020
Revised: November 18, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: January 16, 2021
Abstract
BACKGROUND

Inguinal hernia repair is one of the most common general surgical operations worldwide. We present a case of indirect inguinal hernia containing an expanded portosystemic shunt vessel.

CASE SUMMARY

We report a 72-year-old man who had a 4 cm × 4 cm swelling in the right inguinal region, which disappeared with light manual pressure. Abdominal-pelvic computed tomography (CT) revealed a right inguinal hernia containing an expanded portosystemic shunt vessel, which had been noted for 7 years due to liver cirrhosis. We performed Lichtenstein’s herniorrhaphy and identified the hernia sac as being indirect and the shunt vessel existing in the extraperitoneal cavity through the internal inguinal ring. Then, we found two short branches between the expanded shunt vessel and testicular vein in the middle part of the inguinal canal and cut these branches to allow the shunt vessel to return to the extraperitoneal cavity of the abdomen. The hernia sac was returned as well. We encountered no intraoperative complications. After discharge, groin seroma requiring puncture at the outpatient clinic was observed.

CONCLUSION

If an inguinal hernia patient has portal hypertension, ultrasound should be used to determine the contents of the hernia. When atypical vessels are visualized, they may be shunt vessels and additional CT is recommended to ensure the selection of an adequate approach for safe hernia repair.

Keywords: Inguinal hernia, Lichtenstein’s herniorrhaphy, Portosystemic shunt, Portal hypertension, Shunt vessel, Case report

Core Tip: We present the case of indirect inguinal hernia containing portosystemic shunt vessel. If an inguinal hernia patient has portal hypertension, for example due to liver cirrhosis, ultrasound and/or computed tomography should be used to determine the contents of the hernia. Shunt vessels present in the inguinal canal may be connected to surrounding tissues or communicate with extraperitoneal vessels, such as the peripheral testicular vein. Careful preoperative diagnosis is important to ensure that an adequate approach for safe hernia repair is selected.