The fertility potential appears to be better in children with testis located in the superficial inguinal ring
than in the inguinal canal.
Again, in cases of hernia, strangulation of bowel occurs due to the constriction caused by the internal or the external inguinal rings
. But strangulated bowel obstruction in an inguinal hernia where the bowel is not a content of the hernia sac is unheard of.
In our case ectopic testis was located at the deep inguinal ring
. After separation from the hernial sac the attachments of each testis were dissected from the internal inguinal ring
, the technique provided us sufficient length for the testis to be brought down to lie in Dartos pouch without tension.
In the current case, the deep inguinal ring
was clogged with five testicular veins.
Among the 20 patients operated for bilateral hernia, n=11 (22%) were preoperatively diagnosed as having bilateral inguinal hernia while n=9 (18%) were found to have patent contralateral deep inguinal ring
peroperatively (n=3 on right side, n=6 on left side).
Pocket reached to pubic symphysis medially, 3 cm lateral to deep inguinal ring
, and 3 cm under inguinal ligament and over conjoint tendon.
O degree telescope of 3mm was used to inspect the deep inguinal ring
and contrlaetral ring as well for detection of CPPV.
The morphology of the contra-lateral internal inguinal rings
is age-dependent in children with unilateral inguinal hernia.
Appendix was separated from the sac by adhesiolysis and since it was not inflamed, appendectomy was not performed and after reduction, high ligation of sac was done by gently lifting superficial inguinal ring
. Patient was shifted to the ward.
To preserve a viable testis while preventing escape of intestine from the inguinal canal, the cranial half of the superficial inguinal ring
can be sutured toward the caudally located spermatic cord.
In our case, inguinal hernia was unilateral and contra lateral inguinal ring
was not involved as reported by Alizera et al.
The intra-abdominal testis may be associated with a closed or an open deep inguinal ring
. In the closed ring variant, the processus vaginalis does not develop, the gubernaculum is absent, and the internal ring is closed.