case_images: PMC11752855_01
case_images: Preoperative soft mass of the right ventrolateral abdominal wall
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case_images: During clinical examination, a soft swelling in the right lateral abdominal wall, compressible under palpation was ascertained (Fig. 1).
case_images: Non-contrast abdominal CT, an arrow pointing to the abdominal wall defect and intestine protrusion
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case_images: The abdominal ultrasound and contrast abdominal CT showed a thinned right abdominal wall with superficial intestinal loops and the differential diagnosis of a large recurrent inguinal or Spigelian hernia was presumed (Fig. 2).
case_images: Hernia sac with small intestine loops inside that remained intact during dissection
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case_images: When the sac was completely freed, the final diagnosis of giant recurrent indirect inguinal hernia (Fig. 3), and the sac with its content was repositioned in the abdominal cavity without opening the abdominal cavity and partial closure of the internal iliac ring was performed with resorptive sutures.
case_images: Placement of the polypropylene mesh 15 x 12 cm after dissection of the spermatic cord
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case_images: After the dissection of the inguinal ligament up to the pubic tubercle (without extending the skin incision) a 15 x 12 cm polypropylene mesh was placed (Fig. 4), fixed to the pubic tuberculum and conjoint tendon with a laparoscopic taker (Fig. 5), and the ileopubic ligament partly with individual and partly with continuous non-absorbable polypropylene 2/0 suture.
case_images: Final mesh position with the opening for the spermatic cord
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case_images: An opening for the spermatic cord was provided and medially the mesh was fixed with individual resorptive stitches (Fig. 6).
case_images: Closure of the skin incision
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case_images: The aponeurosis of the external oblique muscle was closed as much as it allowed to be approximated followed by individual subcutaneous and skin stitches (Fig. 7).
case_images: Postoperative abdominal wall restoration
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case_images: One month after the surgical treatment the patient was in good condition without any complaints (Fig. 8).