A peculiar variety of indirect inguinal hernia (juxtacordal indirect inguinal hernia)

BACKGROUND: Indirect inguinal hernias are usually congenital, forming a sac in the core of the spermatic cord covered by the internal spermatic, cremasteric, and external spermatic fasciae(1−3). Direct inguinal hernias are acquired; the sac lies beside/behind the cord(1−3). A rare third type is a combination of indirect and direct sacs on both sides of inferior epigastric vessels(1−3). We describe a rare fourth type, juxtacordal indirect oblique inguinal hernia (Fig. 1), in which the sac emerges through a weakness in the deep inguinal ring, lateral to inferior epigastric vessels, and passes into the inguinal canal beside and in contact with the cord but outside of its covering fasciae. OBJECTIVE: Describes a very rare variety of inguinal hernia. DESIGN: Case reports. SETTING: Tikrit Teaching Hospital/Salahuddin/Iraq. PARTICIPANTS: AND PRESENTATION: The first case; a 5-year-old male with right inguinal hernia, the second case; a 25-year-old man with right inguinal hernia, the third case; a 60-year-old man with right inguinal hernia. INTERVENTIONS: Surgery has been done electively for all. RESULTS AND DISCUSSION: Because the sac emerges through the deep inguinal ring and passes through the inguinal canal, it is an indirect type and because it passes beside the spermatic cord we call it juxtacordal hernia. Because of the thick extraperitoneal fat layer over the sac, we think this hernia is acquired. CONCLUSIONS: Knowing this type of hernia might reduce the risk of inferior epigastric vessels injury and lower the rate of recurrence.