Pantaloon Hernia in a Woman: A Straddling Rarity

Abstract

Introduction: Inguinal hernias are the commonest hernias in males and females. However, direct hernias are rare in females. Pantaloon hernia (combined direct –indirect hernia) is even rarer and there has been a single study reporting the incidence of pantaloon hernia to be 1.6%. Here, we report a 56-year-old female patient who was clinically diagnosed to have right sided uncomplicated, indirect inguinal hernia but intra-operatively found to have a pantaloon hernia. Case Presentation: The patient was a A 56-year-female, diabetic and hypertensive with chronic kidney disease with a right inguinal swelling and a clinical diagnosis of an indirect inguinal hernia, planned for mesh hernioplasty. Intra-operatively, she was found to have 2 hernial sacs on either side of the inferior epigastric artery. The posterior wall was defective along with the entire length of the inguinal canal. She underwent resection of the round ligament with invagination of direct sac by suturing of transversalis fascia and herniotomy of the indirect sac. The posterior wall was reinforced with Lichtenstein tension free polypropylene mesh repair. Discussion: The rarity of direct and hence, pantaloon hernia in women can be explained by the anatomical differences in the inguinal canal and abdominal wall between males and females. Pantaloon hernia is treated as any other inguinal hernia and options of open and laparoscopic repairs including TAPP and TEP are available depending on the surgical expertise and cost factors.  Conclusion: Direct inguinal hernias do occur in women albeit very rarely while pantaloon hernias are extremely rare and when present, may be associated with the testicular feminisation syndrome in young children. The present case is reported with the purpose of documenting the extreme rarity of pantaloon hernia in adult women in the existing scientific literature.