A case of inguinal hernia associated with atypical Dirofilaria repens infection in a dog.

BACKGROUND: Dirofilaria repens is a filarioid nematode transmitted by mosquitoes. Adult D. repens are typically localized in the subcutaneous tissue of the host, but other, atypical localizations have also been reported. There have been several reports of clinical cases involving an association of parasites and hernias in both animals and humans. However, it is unclear if parasitic infection can act as a triggering factor in the development of hernias. METHODS: A 12-year-old dog was referred to a private veterinarian clinic in Satu Mare, northwestern Romania due to the presence of a swelling in the lateral side of the penis (inguinal area). The dog underwent hernia repair surgery during which four long nematodes were detected in the peritoneal serosa of the inguinal hernial sac. One female specimen was subjected to genomic DNA extraction to confirm species identification, based on amplification and sequencing of a 670-bp fragment of the cytochrome c oxidase subunit 1 (cox1) gene. Treatment with a single dose of imidacloprid 10% + moxidectin 2.5% (Advocate, Bayer AG) was administered. RESULTS: The nematodes were morphologically identified as adult D. repens, and the BLAST analyses revealed a 100% nucleotide similarity to a D. repens sequence isolated from a human case in Czech Republic. CONCLUSIONS: We report a case of an atypical localization of D. repens in the peritoneal cavity of a naturally infected pet dog with inguinal hernia and discuss the associations between hernia and parasitic infections.

Case of anisakiasis presenting as an Amyand hernia.

This is a case of a 31-year-old male patient who presented with signs and symptoms of an incarcerated inguinal hernia. The patient's preoperative imaging showed a tubular structure in the inguinal canal and given the patient's history at presentation, there was a concern for herniation of the appendix, known as an Amyand hernia. On laparoscopy, there was no evidence of appendiceal involvement and a standard open inguinal hernia was completed. On the final pathology of the hernia sac, roundworms were identified with Y-shaped lateral cords suggesting infection by Anisakis spp. On a further interview with the patient, he revealed that he had recently travelled to Alaska and had consumed raw salmon on a fishing trip. This case demonstrates the importance of a thorough social and travel history. One should also have a low threshold to broaden the differential diagnosis when medical work-up deviates from the standard course.

Unexpected Infection with Armillifer Parasites.

Visceral pentastomiasis is usually found incidentally during surgery. We describe a case of visceral pentastomiasis discovered during inguinoscrotal hernia surgery for a man from Benin, Africa. Because surgical removal of nymphs is needed for symptomatic patients only, this patient's asymptomatic pentastomiasis was not treated and he recovered from surgery uneventfully.

Extra-gastrointestinal anisakidosis caused by Pseudoterranova azarasi manifesting as strangulated inguinal hernia.

The incidence of anisakidosis continues to increase worldwide due to increased consumption of undercooked fish. Although anisakidosis can be categorized into four clinical phenotypes (gastric, intestinal, ectopic, and allergic), ectopic forms of the condition are much less common than gastric or intestinal forms when caused by Pseudoterranova spp. We report the case of a 5-year-old patient who presented with a rapidly growing left inguinal mass and was subsequently diagnosed with extra-gastrointestinal anisakidosis caused by Pseudoterranova azarasi.

Role of persistent processus vaginalis in hydroceles found in a tropical population.

BACKGROUND: Lymphatic obstruction by Wuchereria bancrofti is thought to be the mechanism for development of tropical hydrocele in men and for elephantiasis, mostly in women. Hydrocele prevalence is used to determine the effectiveness of para site eradication programs. METHODS: We maintained a prospective log of operations performed at 1 Canadian Field Hospital during its relief mission to Léogâne, Haiti. Information regarding duration of symptoms, type of previous surgery (if any), surgical approach, associated inguinal hernia and volume and appearance of hydrocele fluid in patients with tropical hydroceles were recorded. RESULTS: From January to March 2010, 4922 patients were seen, none of whom had elephantiasis. Of the 64 patients who collectively underwent 69 inguino-scrotal procedures, 5 patients had inguinal hernia repair several years after hydrocele excision via the scrotum, 19 patients with bilateral hydroceles underwent a scrotum-only approach, and 45 patients had an inguinal approach (33 unilateral and 12 bilateral) to repair 57 hydroceles. A patent processus vaginalis was present in 50 of 57 (88%) hydroceles where the groin was explored. CONCLUSION: Hydroceles remain common in Léogâne despite successful eradication of filariasis with mass drug administration using diethylcarbamazine-fortified cooking salt. Persistent patent processus vaginalis is a more likely cause than persistent filariasis. There is probably little difference between hydrocele in developed countries and tropical hydrocele other than neglect. Hydrocele prevalence is not a measure of the effectiveness of parasite eradication programs.

Schistosomiasis: an unexpected finding in an inguinal hernia sac.

We report an 11-year-old boy who was diagnosed with schistosomiasis based on histopathologic examination of an inguinal hernia sac specimen. The child was an immigrant from Liberia and presented to our institution with inguinal and scrotal swelling. His past medical history was remarkable for previous ipsilateral hernia sac repair in West Africa, and at the time of his recurrent hernia repair, he was noted to have a peculiar loculated fluid-filled hernia sac, which was sent for pathologic examination because of its unusual appearance. Histologic examination revealed an intense infiltrate of eosinophils and numerous granulomas with ova of Schistosoma mansoni, and this speciation was confirmed with a stool wet prep examination for ova and parasites. Review of the English-language literature uncovered no prior cases of schistosomiasis presenting as an inguinal hernia. This unusual finding in a "routine" specimen, otherwise destined for the incinerator without pathologic evaluation, reinforces the importance of surgical vigilance in recognizing unusual or atypical features in these specimens.

[Two cases of parasitic granuloma found incidentally in surgical specimens].

Occasionally, parasitosis demonstrates no clinical symptoms, and is found incidentally. We report 2 cases of parasitic granuloma found incidentally in surgical specimens in rare sites for parasitosis. Case 1 was a 40-year-old female. She was diagnosed with inguinal hernia, and operation was performed. A white nodule, measured 1.5 x 1 x 1 cm in size, was found in the hernia sac. The nodule was elastic hard and solid. Histologically, eosinophilic granuloma was demonstrated, and the parasite was characterized by renette cell and Y-shaped lateral cord, and suggesting extra-gastrointestinal anisakiasis. Case 2 was a 71-year-old female. She was diagnosed with colonic adenocarcinoma, and colectomy was performed. A white nodule, measured 1 x 1 x 0.8 cm in size was found in the omentum, at first identified as peritoneal dissemination of colonic carcinoma. However, histological findings of the nodule showed eosinophilic granuloma, and parasite was observed in the granuloma. The parasite was characterized by thick cuticle and muscular cells, and suggestive of dilofilariasis. In each case, no clinical symptoms of parasitosis were recognized, and each lesion presented in a rare site as anisakiasis or dirofilariasis. When any lesions as in the present cases is found in a surgical specimen, it is important to make differential diagnosis with consideration for parasitic granuloma.