Pantaloon hernia with two sliding components: The appendix -ascending colon in lateral sac and the urinary bladder in medial sac

Abstract

An inguinal hernia is quite frequent in surgical praxis. One of the rare entities sliding type of inguinal hernia with an incidence of 2%–5%, which is difficult to diagnose preoperatively, most of the time, its diagnosis is made on the operational table. We report a rare case of pantaloon-type hernia with sliding components in either side of the hernia: the appendix, ascending colon onto the lateral, indirect hernia sac, and the urinary bladder onto the medial, direct sac, respectively. The two hernia sacs were saddled on either side of the inferior epigastric vessels. A 77-year-old presented with a right inguinoscrotal swelling for 5 years and increased frequency of micturition for 8 months. The indirect sac was opened very cautiously and was found to contain an appendix, the part of urinary bladder medially and ascending colon laterally forming the sliding component, small bowel, omentum are the contents of sliding hernia. The contents were attenuated and the sac was sealed cautiously. The posterior wall of the right inguinal canal was opened in total, contents were reduced, and neo posterior wall is formed by strengthening, and reinforcement did with prolene mesh. This entity is a diagnostic dispute due to its rarity and defined clinical presentation. Pantaloons hernia with two sliding components is uncommon. The hernia consisted of two parts: a laterally-located indirect sac containing the appendix and sliding ascending colon, and a medially-located direct hernia of sliding urinary bladder. A hernia of long duration in old patients should raise a suspicion of a pantaloon-type hernia. One should be very careful to identify the contents of the hernia to avoid inadvertent injury to the structures.

Keywords

• appendix
• ascending colon
• hernioplasty
• inguinoscrotal hernia
• pantaloon hernia
• sliding hernia
• urinary bladder