Adrenal ectopy and lipoma of an inguinal hernia sac: A case report & literature review

INTRODUCTION & IMPORTANCE: Ectopic adrenocortical tissue is the presence of accessory adrenal cortex tissue located outside of the adrenal glands. It is a rare, incidental finding during inguinal hernia repair. This case report aims to discuss the anatomy and important patient implications related to this finding. CASE PRESENTATION: A 61-year-old male presented with a long-standing right direct inguinal hernia increasing in size and pain frequency. During open right anterior inguinal hernia repair, a lipoma was identified inside the hernia sac and removed. Further histopathological examination of the specimen revealed the presence of adrenocortical tissue inside the lipoma. No further interventions were performed. The postoperative and 2-year follow-up course were uneventful. CLINICAL DISCUSSION: Adrenocortical tissue can parallel the descent of the gonads during embryogenesis, arresting at any point along this path, including the inguinal region. Ectopic adrenocortical tissue is commonly found during inguinoscrotal procedures in infants, suggesting early involution. Its incidence in hernia sacs should be recognized to prevent misdiagnosis as neuroendocrine tumors or melanomas. If adrenocortical tissue is identified during hernia reduction, further surgical exploration is not recommended. In terms of prognosis, endocrine imbalances following surgical removal cannot be ruled out, promoting careful patient monitoring. The lipoma containing the adrenal tissue in our case is a common finding during hernia repair, identified in 22% of patients at operation. CONCLUSION: Ectopic adrenocortical tissue is a rare, incidental finding during inguinal hernia sac analysis in adults. This finding should be well-documented following removal and further studies are required to evaluate long-term outcomes.