Laparoscopic identification of a direct inguinal hernia with bladder involvement in an infant

Abstract

Inguinal hernias are a common problem in premature infants, with incidence increasing as the gestational age decreases. Direct inguinal hernias are rare in infants with minimal documentation in the medical literature. We present the case of a premature infant who was found to have a direct inguinal hernia containing bladder during laparoscopic inguinal hernia repairs. The patient was a premature 25-week gestational age infant admitted to the neonatal intensive care unit. At 3-months old, pediatric surgery was consulted for bilateral inguinal hernias. Intraoperatively, laparoscopic visualization of the hernias demonstrated a typical left indirect inguinal hernia; however, on the right side, we found a direct inguinal hernia, medial to the right medial umbilical ligament that contained a large portion of the bladder. The left indirect hernia was successfully repaired laparoscopically, while the right was repaired with conversion to an open Bassini repair. The postoperative course of the infant was unremarkable.

Keywords

• Direct inguinal hernia
• Pediatric surgery
• Laparoscopic repair