Questions

[Diane]

Hi Steve!
Another great refresher video.

A few questions,
1) Have you ever seen a cord lipoma coexisting with a hernia?
2) Do you have any tips on scanning obese patients where there is just fat everywhere in this region and everything appears to move when straining. Do obese patients have more fat in the inguinal canal?
3) Do all extraperitoneal fat tongues turn into a direct hernia or is it just a precursor?

Thanks!

[Stephen Bird]

Hi Diane,

Good questions,

1: Yes, I have some nice examples of an indirect inguinal hernia coexisting with a cord lipoma.
I have a case where you can see the cord lipoma in the canal and then you see the hernia fat come through the dip ring into the canal and it has to push past the lipoma. I will try and find it and upload it onto this forum.

2: I don’t mind scanning the larger folk, as long as I stick to my technique beginning at the superficial ring in short axis, then superficial ring on long axis, then point the transducer towards the opposite shoulder and move into the canal in short axis, then finally the deep ring and canal in long axis.
If I stick to this logical protocol I don’t get lost and zi have a great understanding about what fat is in the canal and what is outside.
I do think that obese patients have more fat in the canal and I only call it a hernia if it violently enters the canal through the deep ring or through the posterior wall. Otherwise I am happy to cast call it some exztraperitoneal fat in the canal and not a hernia.

3: NO, extraperitoneal fat tongues do not become indirect (I think you meant indirect) hernias. They are completely different as the fat is coming from an exztraperitoneal source and it is not peritoneal fat coming through the deep ring.
So I don’t see them as a precursor for an indirect inguinal hernia.

Steve

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