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A brief on the contents of inguinal hernia

Hernia repair surgery is one of the commonly done surgeries. The inguinal hernia sac usually presents itself with omentum, a layer of peritoneum that surrounds the internal abdominal organs, fat and parts of small intestine. Sometimes they can also contain other contents that are unusual albeit in smaller percentage.

Frequency of unusual contents in inguinal hernia sac

Of all the hernias, the frequency of occurrence of inguinal hernia is pretty much higher than any other and hence the occurrence of unusual hernia contents in the inguinal hernia sac is something any hernia surgeon would encounter definitely during their surgical experience. One estimate puts the occurrence of unusual content at less than 1.5% in all the inguinal hernia cases.

Some unusual contents in the inguinal hernia sac

Appendix (Amyand’s Hernia)

Sometimes the inguinal hernia sac may have appendix inside. This type of hernia is referred as Amyands hernia. Sometimes the appendix so found inside may be with inflammation and may hence present with appendicitis. In such cases an appendectomy is done where the appendix is removed and post that the hernia repair surgery is done. Sometimes the appendix so found inside the inguinal hernia sac may not show any infection and hence may not present with any appendicitis symptoms. The surgeon may choose to reduce or replace the appendix to its original position and repair the hernia defect alone. Generally if the appendix is not inflammed, the surgeon reduces the appendix because the hernia mesh has to be placed to repair the hernia.

Circumference of bowel (Richter’s hernia)

When one wall of the intestine protrudes into the inguinal hernia sac, then only the circumference of the bowel is found inside the sac. This condition is termed Richter’s hernia. It is relatively a rare condition but if not found out it may lead to necrosis of the circumference part that is bulging inside. Any necrosis has to be surgically attended to immediately.

Two loops of bowel (Maydl’s hernia)

When two loops of bowel are found in the single inguinal hernia sac, it is termed as Maydl’s hernia. The loops form a typical “W” shape inside the hernia sac. This condition is extremely rare and is more prone to develop strangulation and necrosis.

Meckel’s diverticulum (Littre’s hernia)

Meckel’s diverticulum is a small bulge in the small intestine. It is said to be a vestigial remnant. Only a small portion of the population (2%) retains this bulge in the small intestine. Sometimes this vestigial organ is found inside the inguinal hernia sac and is termed as Littre’s hernia. Since it is a vestigial organ, the surgeon proceeds to remove this bulge permanently and then perform the hernia repair surgery.

Other unusual contents of the inguinal hernia sac

Sometimes other unusual contents like urinary bladder, ovarian cyst and Fallopian tubules, sigmoid colon and cecum are also found in the inguinal hernia sac albeit rarely. The surgeon while performing hernia repair surgery, places these organs in their right position carefully and then repairs the abdominal wall for its breach.

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