Management of Ovarian Hernia in Children, in Teaching Hospital of Bouaké, Côte d’Ivoire Prise en Charge des Hernies de l’ovaire de l’enfant au CHU de Bouaké, Côte d’Ivoire

Objective: To analyze our experience in the management of ovarian hernia in children. Methods: It was a retrospective study about 11 cases treated in pediatric surgery unit of the Teaching Hospital of Bouaké, in 2 years period. Results: Ovarian hernia represented 7.69% of the hernias and 73.33% of the hernia cases in girls. The mean age was 4 years and the median 36 months. The main reason for consultation was inguinal swelling (45.45%) following by swelling of the labia majora (36.36%), and a round mass of labia majora palpated by parents while bathing the child (18.18%). Nine (9) patients had been operated on;we realize the closure of peritoneo-vaginal canal, associated in 66.66% cases with a routine surgical exploration of the contralateral side. Average age of these children with contralateral hernia was 20 months. The mean follow up was 6 months (15 days - 15 months). We noticed an appearance of contralateral ovarian hernia in a girl operated on at 3 years old without routine surgical exploration. Conclusion: We recommend early management with a systematic surgical exploration of the contralateral side in young female child. A preoperative ultrasonography could be a routine in case of strangulated hernia, if available.

Unusual Contents of Inguinal Hernia Sac. An Approach to Management

Background-Unusual contents of hernia sac are uncommon, but are likely to be encountered by a surgeon in his career due to the frequency of hernia repair. The aim of this study, is to present our experience of unusual contents in inguinal hernia sac, discuss its management and review the relevant literature with regards to others experience. Patients and methods-Retrospective study of 662 patients who underwent inguinal hernia repair over an 8 year period from 2000 to 2008 was carried out. Results-Seven patients presented with unusual contents in inguinal hernia sac;an incidence of 1.05%. Three of them had vermiform appendix, with acute appendicitis (Amyand’s Hernia) noted in one of them. All patients underwent appendicectomy with repair of hernia, with mesh being employed only in patients with normal appendix. In 2 cases urinary bladder had herniated and there was one case each of ovarian cyst and fallopian tube with ovary as its content. In all these patients hernia repair was carried out after carefully reducing the contents. Conclusion-Unusual contents of hernia may pose a surgical dilemma during hernia repair even to an experienced surgeon. Although rare, a hernia may contain vermiform appendix and exceptionally it may be acutely inflamed. Tubal and ovarian herniation in an inguinal hernia may be found in adult and perimenopausal women, though the incidence is reported to be more common in children. Urinary bladder herniation occurs with similar incidence as tubo ovarian hernia;however it requires special attention because of the risk of iatrogenic bladder injury during inguinal dissection. Though appendix as a content is dealt with by appendicectomy followed by hernioplasty, every effort should be made to preserve other organs found in the hernia sac to achieve an uneventful postoperative period.

Adnexal Sliding Hernia in an Infant: Clinical-Anatomical Case Report

We present a case report of laparoscopic herniorrhaphy in an infant with ovarian prolapse. Using this case study, we demonstrate the role of the ovarian ligamentous apparatus. A structure appearing like the male gubernaculum was identified. The anatomical and functional role of this “gubernaculum” will be the subject of discussion. Further detailed laparoscopic examinations are indicated to better understand the ligamentous anatomy of ovarian prolapse.

卵巢嵌顿疝致卵巢坏死的危险因素分析

目的 分析女性婴幼儿卵巢嵌顿性腹股沟斜疝导致卵巢坏死的危险因素。方法 回顾性研究昆明市儿童医院2018年6月1日至2021年6月1日间,57例女性婴幼儿卵巢嵌顿性腹股沟斜疝(以下简称为卵巢嵌顿疝)并行手术的患儿,分析患儿的年龄、临床资料、实验室检查、术中有无卵巢扭转,并进行单因素及多因素Logistic回归分析。结果 共纳入57例女性婴幼儿,中位年龄46 d,最小年龄19 d,最大年龄2岁5月。57例患儿均行手术治疗,术中均证实为卵巢嵌顿。单因素分析结果显示白细胞、CRP、卵巢扭转与卵巢坏死有关(P <0.05),多因素分析提示卵巢扭转是术中卵巢坏死的独立危险因素(OR=1.390,95%CI:1.056-1.829,P=0.019)。结论 卵巢扭转是婴幼儿卵巢嵌顿性腹股沟疝发生卵巢坏死的独立危险因素。

女性婴幼儿腹股沟卵巢嵌顿斜疝一例报告

卵巢疝常见于婴幼儿,属于婴幼儿急症,因症状及体征不典型,容易误诊和漏诊。该文报道1例婴幼儿卵巢疝病例,患儿2岁,因“家属发现其左侧腹股沟肿物伴疼痛2 d”入院。主诊医师根据其临床症状及彩色多普勒超声检查诊断为左侧嵌顿性腹股沟斜疝(左卵巢嵌顿疝?),明确无手术禁忌证后及时实施左侧嵌顿性腹股沟斜疝松解+修补术,术程顺利,术中成功保留患儿卵巢,术中诊断为左侧嵌顿性腹股沟斜疝(左卵巢嵌顿疝)。婴幼儿腹股沟斜疝易发生嵌顿,女性患儿嵌顿内容物可能为卵巢,卵巢嵌顿坏死对女性影响极大,因此,早期诊断、及时手术,安全有效地保留卵巢极为重要。

卵巢疝1例报告并文献复习

目的探讨卵巢疝的临床特征、诊断、治疗及预后。方法回顾性分析中国医科大学附属盛京医院2018-07-18收治的1例卵巢疝病例的临床资料,并对国内外相关文献进行分析及总结。结果患者30岁,以“取卵后外阴疼痛1d,加重4h”为主诉入院。彩超提示:左侧阴阜部见5.2cm×3.6cm×3.5cm包块,考虑为外阴肿物,为明确诊断遂行MRI检查,提示卵巢疝。急诊行腹股沟疝高位结扎修补术+卵巢修补术,术中成功保留卵巢。查阅国内外相关文献共检索到6篇共6例已报道病例,显示该病常表现为自觉腹股沟包块、下腹痛或无症状;治疗方法以手术为主;对于年轻女性,需早期诊断、早期治疗,尽可能保留卵巢。结论对于患有卵巢疝的育龄女性,建议根据临床症状早诊断、早治疗,避免误诊,以多模式和多学科的方法,安全和有效地保留卵巢功能。

开放式TEP在妇科手术联合疝修补中的应用

目的探讨开放式TEP在妇科手术联合疝修补中的应用及优势。方法选取吉林大学第二医院2011年9月至2012年9月经手术治疗妇科疾病并同时应用开放式TEP治疗腹股沟疝的患者20例。观察手术时间、住院时间、并发症及复发情况。结果所有患者均恢复良好,手术耗时(从关闭腹膜开始)平均28min,平均住院时间为7.2d,恢复正常活动时间为5.8d;术后血清肿2例,无切口感染及神经性疼痛,术后随访6～18个月,无复发。结论行手术治疗妇科疾病同时行开放性TEP治疗腹股沟疝,具有损伤小(单一切口)、手术耗时短、治疗费用低等优势,值得推广。

婴幼儿腹股沟卵巢疝临床分析并文献复习

目的探讨女性婴幼儿腹股沟卵巢疝(IOH)的超声及临床特点,并进行文献复习。方法选择2020年12月21日于四川大学华西第二医院就诊的1例11个月20d龄左侧I0H患儿(患儿1)为研究对象。采用回顾性分析法,收集患儿1超声及临床资料。对患儿1的超声及临床表现与治疗、预后等进行分析。以“卵巢疝”“婴幼儿”“超声”“腹股沟”“嵌顿疝”“ovarian hernia”“infant”“ultrasound”“inguen”“incarcerated hernia”等为中、英文关键词,在中国知网、万方数据知识服务平台及PubMed数据库中,检索婴幼儿IOH患儿相关研究文献,文献检索时间设定为2010年1月1日至2022年12月31日。本研究遵循的程序符合2013年新修订的《世界医学会赫尔辛基宣言》要求。结果①患儿1因“左侧腹股沟区包块(IM)10+个月”于病例收集医院住院治疗。人院时,其双侧腹股沟彩色多普勒超声检查结果提示,双侧腹股沟疝(左侧疝内容物为卵巢及肠管、右侧疝内容物为肠管),双侧团块内均探及血流信号。对患儿1采取腹腔镜下双侧腹股沟疝修补术治疗后,第3天病情好转出院。②文献复习结果:根据本研究设定的文献检索策略,检索到超声诊断婴幼儿IOH相关研究文献为28篇,涉及68例≤6岁女性I0H患儿(患儿2~69)。加上患儿1共计69例患儿(患儿1~69)的临床资料分析如下。65例患儿的首发症状均为IM,4例伴反复哭闹不止。对69例患儿均采取手术治疗,术中证实67例为单侧IOH(33例合并卵巢嵌顿、3例合并输卵管疝、3例合并子宫疝、4例合并双侧卵巢和子宫疝人单侧腹股沟),2例为双侧IOH(均合并卵巢嵌顿)。术中发现卵巢组织坏死为13例[12例术前彩色多普勒超声提示腹股沟包块未见血流信号,仅1例可见;12例经手术切除卵巢,包括2例伴卵巢扭转者,1例未切除卵巢的后期超声随访结果显示,卵巢严重萎缩」,其余56例患儿术中疝人腹股沟卵巢回纳后,预后良好。结论超声检查可辅助临床诊断婴幼儿IOH,其超声表现主要为腹股沟见卵巢样回声。手术治疗是该病患儿主要治疗方法。对于超声结果提示IM女婴,需警惕IOH可能,早诊断、早治疗婴幼儿IOH,可避免卵巢坏死,保护患儿卵巢功能。