THE ETIOLOGY OF THE ADULT INDIRECT INGUINAL-HERNIA - REVISITED

It has generally been historically stated that indirect inguinal herni as develop only in patients who have a patent processus vaginalis that enlarges to become a hernia sac. Occasionally, this theory has been c hallenged but without any objective evidence. Herniography was perform ed by placing 50 mt of nonionic contrast material into the peritoneal cavity. The patient was then placed in a prone position with the head of the table elevated. Films of the inguinal fossae were obtained with the patient straining. The herniogram revealed a right indirect ingui nal hernia. There was no left inguinal hernia, nor was there a patent processus vaginalis on the left side. Two years later, the patient dev eloped left inguinal discomfort and swelling and was found to have a m oderate-sized left inguinal hernia. At the time of operation, an indir ect:sac of moderate size was present. A mesh plug repair was performed . This case report is the first published objective evidence that, con trary to common thought, a patent processus vaginalis is not a necessa ry prerequisite to the development of an indirect inguinal hernia.