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Re: Improper surgical technique

Dear Editor

In the case reported by Goyal et al. regarding the presence of a gastrointestinal tumour in a hernial sac, it appears that poor surgery is being passed off as a "lesson" to be learnt by the readers. The presence of a haematoma in an otherwise empty hernial sac should definitely alert the surgeon to the presence of strangulated bowel which has probably reduced into the peritoneal cavity. Having made a preoperative diagnosis of an irreducible inguinal hernia, appropriate measures should have been taken while delivering the sac inorder to prevent spontaneous reduction so that the contents can be inspected and if they had landed up in the situation described in the case report, a laparotomy was mandatory.

The short duration of symptoms should have prompted the caregiver to think of alternate diagnoses as well.

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Re: Author's reply

Dear Editor

We agree with V Ramachandran that the presence of blood in an empty hernial sac should have prompted the surgeon to perform an exploratory laparotomy. The case report reinforces this basic surgical principle and highlights that intra-abdominal malignancy may rarely present as an inguinal mass and lead to blood in the sac.