Open Access Case Report

Pantaloon Hernia in a Woman: A Straddling Rarity

Rajat Choudhari, V. Pon Rachel, Pranay Gaikwad

Asian Journal of Case Reports in Surgery, Page 1-5

Introduction: Inguinal hernias are the commonest hernias in males and females. However, direct hernias are rare in females. Pantaloon hernia (combined direct –indirect hernia) is even rarer and there has been a single study reporting the incidence of pantaloon hernia to be 1.6%. Here, we report a 56-year-old female patient who was clinically diagnosed to have right sided uncomplicated, indirect inguinal hernia but intra-operatively found to have a pantaloon hernia.

Case Presentation: The patient was a A 56-year-female, diabetic and hypertensive with chronic kidney disease with a right inguinal swelling and a clinical diagnosis of an indirect inguinal hernia, planned for mesh hernioplasty. Intra-operatively, she was found to have 2 hernial sacs on either side of the inferior epigastric artery. The posterior wall was defective along with the entire length of the inguinal canal. She underwent resection of the round ligament with invagination of direct sac by suturing of transversalis fascia and herniotomy of the indirect sac. The posterior wall was reinforced with Lichtenstein tension free polypropylene mesh repair.

Discussion: The rarity of direct and hence, pantaloon hernia in women can be explained by the anatomical differences in the inguinal canal and abdominal wall between males and females. Pantaloon hernia is treated as any other inguinal hernia and options of open and laparoscopic repairs including TAPP and TEP are available depending on the surgical expertise and cost factors. 

Conclusion: Direct inguinal hernias do occur in women albeit very rarely while pantaloon hernias are extremely rare and when present, may be associated with the testicular feminisation syndrome in young children. The present case is reported with the purpose of documenting the extreme rarity of pantaloon hernia in adult women in the existing scientific literature.

Open Access Case Report

Giant Right Liver Haemangioma Associated with Kasabach-Merritt Syndrome in an Adult Patient

Abdelkader Boukerrouche

Asian Journal of Case Reports in Surgery, Page 1-5

Introduction: Liver haemangiomas are often asymptomatic and diagnosed incidentally. Kasabach-Merritt syndrome (KMS) or consumptive coagulopathy is a rare but life-threatening complication of liver haemangioma occurring during observation. Surgery is an appropriate treatment option in such condition and coagulation usually returns to normal after surgical excision. We herein report a case of giant right liver haemangioma with Kasabach-Merritt syndrome treated surgically with literature review.

Case Presentation: A 36 –year old woman with a giant liver haemangioma (20 cm) discovered three years ago, who presented to emergency department for pallor and fatigability and no abnormalities were found on physical examination. After excluding haematologic diseases, a Kasabach-Merritt syndrome associated with giant liver haemangioma had been retained. Coagulation disorders returned to normal after successful surgical resection of the lesion by performing a right hepatectomy.

Conclusion: Resection is an appropriate and effective surgical procedure to treat giant liver haemangioma associated with Kasabach-Merritt syndrome.

Open Access Case Study

An Impacted Denture in the Hypopharynx - A Quick Intervention Reduces Morbidity

Shuaib K. Aremu, Abdulwasiu Salman, Omotosho Wasiu

Asian Journal of Case Reports in Surgery, Page 1-4

A 32-year-old male police officer was brought to Accidents and Emergencies on account of ingestion of a denture while trying to drink his medications, 4 hours prior to presentation in our facilities. He reported immediate painful distress, a choking sensation, cough and mild difficulty in breathing. A plain radiograph showed opacification with increased prevertebral soft tissue shadow in the region of C4-C5 of the hypopharynx. The emergency examination was conducted under general anaesthesia and the foreign body was extracted from the throat. Immediate post-operative condition was satisfactory. This case is reported to demonstrate the importance of properly anchoring artificial dentures, and as a reminder to people with artificial dentures to exercise caution when taking medications. Early presentation and quick intervention, as described in this case study, are vital to prevent serious morbidity which may occur as a result of such a condition.

Open Access Case Study

Skull Parosteal Lipoma - Hard Lump on the Head of Bony Origin?

Muhammad Nur Dinie Bin Abdul Aziz, Richard Sim

Asian Journal of Case Reports in Surgery, Page 1-5

Aims: A skull parosteal lipoma is extremely rare with only 4 cases reported in the recent literature. This is in contrast to other parosteal lipomas that occur more commonly in the long bones of the upper and lower limbs. In this report, we present the fifth case of skull parosteal lipoma according to our comprehensive literature review.

Case Presentation: A 67-year old gentleman with well controlled hypertension presents with a painless right frontal swelling of three year’s duration. He recalls prior blunt injury to the right frontal area 6 years ago. Magnetic resonance (MR) imaging scan of the head was performed and demonstrated a well-circumscribed subperiosteal lesion in an otherwise asymptomatic patient. With a diagnosis of a benign lesion that was asymptomatic, the patient was not offered surgery and the lesion has since remained stable.

Discussion: The aetiology of parosteal lipoma is unknown. Local trauma on long bones has been associated with subsequent parosteal lipoma several years later. In this patient, we suggest that there may be possible association with previous trauma. MR imaging can delineate the tissue layer of origin and demonstrate a lesion with the same attenuation value and intensity signal as adipose tissue.

Conclusion: A skull parosteal lipoma may be differentiated from other differentials with adequate physical examination and appropriate imaging technique. MR imaging has been shown to be useful to exclude other differentials such as an angular dermoid cyst. Surgical resection with wide excision margins may be performed to obtain a histopathological diagnosis.

Open Access Case Study

Gas Shadow in the Abdomen - Rare Manifestation of a Common Condition

Muhammad Nur Dinie Bin Abdul Aziz, Richard Sim

Asian Journal of Case Reports in Surgery, Page 1-4

Aims: Diverticular disease is common in the ageing population, and this trend is also seen in Asians. A rare manifestation of this condition is a giant colonic diverticulum, defined as a sac-like protrusion of the colonic wall larger than 4 cm. Here we report a case of a patient who presented with an abdominal mass causing mild discomfort who was later found to have a giant colonic diverticulum on a background of known diverticular disease.

Case Presentation: A 52-year-old lady presented with bloating and a non-tender abdominal mass three months after successful medical treatment of acute diverticulitis. CT imaging revealed a 5cm contained air pocket with minimal surrounding inflammatory fat stranding. She was diagnosed to have a GCD and underwent a laparoscopic sigmoid colectomy which confirmed a giant diverticulum of the descending colon on histopathology.

Discussion: The most common aetiology of giant colonic diverticulum is post-inflammatory subsequent to focal perforation of an existing colonic diverticulum. Surgery is recommended as a GCD is usually symptomatic and there is a higher risk of complications if it is left in-situ

Conclusion: With the rarity of this disease entity in the Asian context, a surgeon encountering giant colonic diverticulum may have limited experience in managing it. Surgery is the mainstay treatment modality and consists of resection of the giant colonic diverticulum en-bloc with the adjacent colon.