Inguinal hernia repair is one of the most common operations performed in general surgery worldwide. It may contain either the omentum or small bowel as its contents. However, during hernia surgery, there may be surprises due to encounter of rare or unexpected contents in the hernial sac. Among these are Meckel’s diverticulum, Amyand’s hernia, Rhicter’s hernia, bladder, fallopian tube and ovary. We present a case of herniolithiaisis which was a term given for ‘stone’ in the hernial sac by Singal et al., in their case report. The first case of stone in the hernial sac was reported by Mazdak et al in 2007. Our patient, a 56 year old diabetic gentleman presented with bilateral inguinal hernia, left larger than the right with a left hydrocele. He was posted for left hernioplasty and hydrocelectomy.  Intraoperatively, a direct hernia with omentum and bowel as contents was seen. There was a 2x2 cm stone adherent to the omentum at the fundus of the sac. Biochemical analysis of the stone revealed calcium and oxalate as its main constituents. Herniolithiasis or stone in the hernial sac is an exceedingly rare entity. Chronic infection and inflammation of part of the omentum has been hypothesised to cause saponification, calcification and stone formation. In this report, we intend to present such an encounter during hernia surgery and briefly outline the other rare contents in the herinal sac. It is important that the operating surgeon is aware of various unexpected contents in the hernial sac during hernia repair in order to plan proper surgery.

Keywords: inguinal hernia, herniolithiasis, stone in hernial sac.

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Dr Coelho Victor

Assistant Professor, Division of Surgery, Unit IV, Christian Medical College Hospital, Vellore- 632002, Tamil Nadu, India