Abstract
The patient was in his sixty who had been followed at a neighboring hospital for pancreaticobiliary maljunction presented at our hospital because of a 3-month history of a bulge in the left groin. On physical examination, a reducible golf-ball-sized bulge just cephalad to the left inguinal ligament was detected, which was diagnosed as an inguinal hernia. The operation was performed via an anterior approach. The posterior wall of the inguinal canal had diffusely enlarged, and type II-3 inguinal hernia was diagnosed according to the Japan Hernia Society (JHS) Classification. Further intraoperative survey revealed associated another hernias, JHS I-2 and JHS III. From these operative findings, ipsilateral coexistence of direct, indirect and femoral hernias was diagnosed, for which modified Kugel herniorrhaphy was performed to cover the entire myopectineal orifice. A review of the PubMed and Web Japan Medical Abstracts Society revealed only four such cases.
