A Contradictory Management of Direct Inguinal Hernia in Pediatric Age Group

Dear Sir,

We are writing to share, not so rare yet underreported surgical condition – direct inguinal hernias (DIH) in children, accounting for (0.5% to 1%) of all groin hernias. Usually, DIHs are diagnosed as recurrent indirect inguinal hernias, or when a fascial defect, medial to inferior-epigastric vessels is noted with absence of typical indirect hernial sac.[1] There is only one repair technique, i.e., posterior wall reinforcement, described in the literature. With the advent of laparoscopy, diagnosing and managing DIHs have become more convincing. Yet, only one study has been reported from India by the General Surgery department (Nalanda/Darbhanga Medical College, Bihar).[2]

Recently, we encountered a 3-year-old boy with right inguinal swelling, which was initially diagnosed by ultrasound as an indirect inguinal hernia. However, intraoperative laparoscopic findings confirmed a DIH. A contradictory but successful laparoscopic herniotomy with sac excision and purse-string suturing, without any posterior wall reinforcement, was done [Figure 1]. After 1-year of follow-up, there is no recurrence. With this case, we are raising awareness regarding different management options in underreported cases of DIH.

Figure 1.

(a) Right inguinal hernia defect seen medical to the inferior epigastric vessels – direct inguinal hernia, (b) complete excision of the hernia sac, (c) purse-string suturing with 3-0 round body polypropylene suture was done

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.