The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I was recently diagnosed with an inguinal hernia (cord lipoma). Please help.
Hello,
Welcome to icliniq.com.
Thank you for consulting us.
Inguinal hernia is a common problem. It is a protrusion of abdominal content through the deep ring of the abdomen to the canal and then can reach down to the scrotum. Repair should be done surgically with a mesh, a 45 minutes procedure. It can be done through laparoscopy, or an open operation can be carried out using a mesh. Lipoma of the cord is a different thing. It is a lipid accumulation on the spermatic cord in the inguinal canal, which needs excision without repair through the same incision on the inguinal canal. Both are clean surgeries and done with fewer complications if performed by a senior surgeon. Recovery time is about six weeks, and you can return to full activity after three months.
If you have any more queries, please let me know.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply, doctor.
My question is regarding scar tissue on my pelvis. I recently had some scar tissue removed in the pelvis, and the surgeon says he found an inguinal hernia (not recurrent or a new hernia, or evidence of mesh failure). The original hernia was a fatty type, and it was repaired by placing a mesh. I have had MRI scans after the hernias were repaired by mesh. They found hydroceles that I had never had before the hernia mesh surgery. Is it possible that if an inguinal hernia (lipoma) is not reduced or surgically removed, but the mesh is placed anyways, the hernia could make its way to the scrotum (since the hernia would have nowhere else to go because of the mesh)?
Hello,
Welcome back to icliniq.com.
Thank you for writing. I can understand your concern.
Usually, once the hernia is repaired, the mesh is placed, there should be no more hernia. However, the hydrocele shown on MRI (magnetic resonance imaging) is a complication that might occur following hernia repair. The accumulation of fluid in the tunica vaginalis layer results from an imbalance between production and absorption of the fluids. It is not a reoccurrence, but it is a complication after the hernia repair, which can be corrected by another operation that can fix the scrotum to invert the tunica vaginalis. Please note small hydrocele does not need surgery, but big ones need.
Kind regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I wanted to know if it is possible that if an inguinal (lipoma) is not reduced or surgically removed, but the mesh is placed anyways, the hernia could make its way in the scrotum (since the hernia would have nowhere else to go because of the mesh)?
Hello,
Welcome back to icliniq.com.
Yes, it is possible that a hernia can make its way to the scrotum.
Patient's Query
Hello,
Thank you for the reply, doctor.
Hello,
Welcome back to icliniq.com.
You are welcome.
Patient's Query
Hello doctor,
Passing light from the back of the scrotum to the front is the test for hydrocele or any other mass. Is this something that can be performed at home? Of course, I would need to see a professional to be sure, and I am just talking about it as a preliminary test before confirming from a qualified healthcare provider.
Thank you.
Hello,
Welcome back to icliniq.com.
You need an ultrasound of the scrotum to confirm rather than a transillumination test. But in my view, the MRI you have done is much better than all.
Patient's Query
Hello doctor,
Thank you for the reply.
Can lipoma in the scrotum be mistaken for hydrocele?
Hello,
Welcome back to icliniq.com.
No, it cannot be mistaken like that. Hydrocele is related to water, and lipoma is related to fat.
Patient's Query
Hello doctor,
Thank you for the reply.
I have attached the pathology report of the hernia sac the surgeon removed. In the notes, he says no recurrent hernia or new hernia. Therefore, it must have been the original hernia. My question is whether the bilateral fat-containing inguinal hernias the same thing as cord lipoma?
Hello,
Welcome back to icliniq.com.
According to the reports (attachments removed to protect the patient's identity), bilateral fat hernia means a component of the hernial sac is fat, likely omentum. A lipoma is a fat arising from the cord itself. So there is no hernial sac.
Patient's Query
Hello doctor,
Thank you for the reply.
I have attached a few pictures below.
The first image is a screenshot of the CT findings describing the type of hernia. The second image is a screenshot from the outpatient notes from hernia surgery, for which a CT scan was used to diagnose by the surgeon who did my hernia surgery. Suppose the finding on the CT was small bilateral fatty hernias; why do the outpatient notes say he repaired cord lipomas and not bilateral fatty hernias?
Hello,
Welcome back to icliniq.com.
The hospital notes (attachments removed to protect the patient's identity) sometimes say about lipoma as a hernia. However, the main and most accurate is the operation notes, which the surgeon writes. Anyway, the lesion was repaired. So do not worry.
All the best.
Patient's Query
Hello doctor,
Thank you for the reply.
That was from the official outpatient notes from the surgeon. There is something questionable about my hernia surgery. What is mature adipose tissue that is consistent with hernia contents?
Hello,
Welcome back to icliniq.com.
The reports (attachments removed to protect the patient's identity) showed it is a hernia and not a lipoma on the cord. But it is fine since it is reduced. But I am interested in the dimensions of the hydrocele. I mean, how big is it?
Patient's Query
Hello doctor,
Thank you for the reply.
The hydrocele is not important now. On a radiology report, the terminology reading says small bilateral fat-containing inguinal hernias. Is this terminology used to describe the lipoma of a spermatic cord?
Hello,
Welcome back to icliniq.com.
Yes, once a radiology diagnosis confirms hernia, then it is not lipoma of the cord.
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