What else could a Lipoma be?

In a follow up to the post on What else could an Umbilical hernia be? a strikingly similar experience prompts this post.

A fairly large lady of middle eastern descent presented to us with a soft, non expansile, mobile, swelling over her left thigh just about where the groin fold meets the leg. She said she'd had it for years and it gave her no trouble other than cosmetic and she wanted it taken out for that specific purpose.

She underwent a Sonogram which confirmed our clinical diagnosis of it being a Lipoma. Happy with our findings we posted her for surgery under local anaesthesia (which is usually the case) in day care!

We started off, dissected around it, it looked like a lipoma and we dug deeper and higher. Down to the muscle layer, carefully avoiding the femoral vessels. Until we reached what we thought was the femoral canal. She was under local so we asked her to cough. No impulse. Asked her again. No impulse. No luck either as my finger was going all the way up through what was now confirmed as the femoral canal.
This was no lipoma. It was a full fledged femoral hernia!

Luckily the anaesthetist was close by and was able to reach us in 10 minutes. We carried out the repair completely and the lady is doing fine.

I wonder what else a lipoma could be? Until I find another presentation.....

Appendicular Hernia

Very interesting case.

This lady had an incisional hernia where her umbilicus should have been. She had undergone an abdominoplasty (like a tummy tuck / liposuction) someplace and had come here for the hernia which had recently become irreducible. The plastic surgeon who did the abdominoplasty obviously wasn't very good at his job because along with the obvious incisional hernia, he also managed to give her some really ugly dog-ears at either end of her scar!

Anyway, we went in laparoscopically and as expected we found a large defect with the previous surgical sutures cutting through the sheath. The contents were clearly bowel and we started reducing them into the abdominal cavity. As we reached towards the end, we realised that the lead to the contents was actually her appendix. It formed the engine that led the entire train of bowels to enter through the defect and lie in the subcutaneous tissue!

We started the meshplasty using our technique of unabsorbable sutures and a port closure needle. Somewhere between the 2nd and 3rd tie, the needle bent to such an angle that we thought it was broken for good. To make matters worse, the only other needle in the OT was unsterile, and the needle from our personal set was not with us at that point in time. We sent the 2nd needle for sterilisation and tried innovative methods in the meanwhile to try and continue the sutures. We tried using a Veress Needle (didn't work), intracorporeal suturing (worked for distant sutures but not for the ones close to the camera port and tackers.

Finally after prolonging for an hour unnecessarily, we got the second needle and finished the case in 3 hours for what should have taken us 1.