Presentation
Had cholecystectomy (midline laparotomy) with right inguinal hernia repair 5 years ago. Presented with an umbilical swelling. Preoperative CT.
Patient Data
Age: 75 years
Gender: Male
From the case:
Plugoma
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The CT scan demonstrates:
- hernial sac along the right inguinal canal containing mesenteric fat and small lobulated well-demarcated oblong nodule (mesh plug) measuring 35 x 25 mm protruding into the inguinal canal. In addition to the subcutaneous scar, its location posterolateral to the epigastric artery indicates that the patient was operated for an indirect inguinal hernia.
- incisional hernia of the anterior midline abdominal wall at the umbilical region, containing mesenteric fat.
other findings:
- dysmorphic liver with no focal lesion seen
- small right renal stone
- bilateral renal sinus cysts with simple left cortical renal cysts
- small sliding hiatus hernia
- degenerative changes of the lumbar spine
Case Discussion
The use of a prosthetic mesh plug during inguinal hernia repair may be mistaken for inguinal mass or lymphadenopathy, especially if the patient is known for cancer (overstaging of malignancy), which exposes the patient to unnecessary workup or even surgery.
The radiologist, as well as the surgeon, should be familiar with these normal postoperative CT findings. The surgical history of inguinal hernia repair will certainly help the radiologist in the interpretation of such findings.
Additional contributor: A. Ramdani, MD
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