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An unusual inguinal hernia

Published:December 01, 2016DOI:https://doi.org/10.1016/j.ejim.2016.10.010

      1. Indication

      A 31-year-old man had a medical history of right inguinal hernia operated two years earlier. He presented at the emergency department with a 3-day history of painful scrotal tumefaction (Panel A). (See Fig. 1.)
      Fig. 1
      Fig. 1PANEL A: scrotal tumefaction. Panel B: surgical view of the testicle during examination showing dilatation of lymphatic vessels. PANEL C: Giemsa staining allowing identification of Wuchereria bancrofti, one of the agents of lymphatic filariasis.
      He had no associated fever and laboratory tests were normal. Clinical examination was consistent with a strangulated inguinal hernia, and immediate surgery was performed. Intraoperative observation didn't reveal any groin hernia but showed a scrotal exudate and an important dilatation of lymphatic vessels (Panel B shows a surgical view of the testicle during examination, black arrow shows dilated lymphatic vessels). The patient, native from Ghana, reported after interrogation an intermittent swelling of the scrotum for the last 3 months. Analysis of a peripheral blood smear drawn at midnight showed the presence of moving little worms.
      What is the diagnosis?
      Analysis of a peripheral blood smear was consistent with microfilariae. Giemsa staining allowed identification of Wuchereria bancrofti (Panel C), one of the agents of lymphatic filariasis.

      2. Diagnosis

      Lymphatic filariasis is a parasitical disease that is endemic in many countries in the world. It involves the lymphatic system, leading to lymphedema, hydrocele or elephantiasis. In northern countries, lymphatic filariasis is rare and can be mistaken with inguinal hernia [
      • Bockarie M.J.
      • Taylor M.J.
      • Gyapong J.O.
      Current practices in the management of lymphatic filariasis.
      ,
      • Jones R.T.
      Non-endemic cases of lymphatic filariasis.
      ].
      The patient was treated by doxycycline for 3 weeks, followed by a single dose of ivermectin repeated 6 month later. The outcome was favorable with no sequelae.

      Contributors

      AM provided care for the patient. All authors wrote and revised the manuscript.

      Funding information

      This report received no specific funding.

      Conflict of interests

      There are no competing interests.

      Informed consent

      Written consent to publication was obtained.

      Ethics committee approval

      Not applicable.

      References

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        Current practices in the management of lymphatic filariasis.
        Expert Rev Anti Infect Ther. 2009 Jun; 7: 595-605
        • Jones R.T.
        Non-endemic cases of lymphatic filariasis.
        Trop Med Int Health. 2014 Nov; 19: 1377-1383