Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.509
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
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.
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.
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.
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.