What is the treatment for atypical tuberculous adenitis in patients with abdominal hernias?

Updated: Jul 23, 2019
  • Author: Assar A Rather, MBBS, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Atypical tuberculous adenitis is best treated by means of local excision. Repeated trauma may cause painful reactive inguinal or femoral lymph nodes. Excision of the involved node relieves symptoms. The potential for malignancy in a femoral canal mass that persists despite antibiotic therapy warrants biopsy. Any enlarged lymph node that is excised should be divided, with one half sent fresh for lymphoma protocol and the other half sent to microbiology. A suspected femoral hernia, usually after a missed inguinal hernia repair, also warrants exploration.

The best approach for both adenopathy and femoral hernia is a preperitoneal approach. Reduction of an incarcerated intestine is easy, and there is clear access to the lymph node. A pectineal ligament repair or laparoscopic mesh placement closes the opening into the femoral canal. Groin incisions usually heal better than thigh incisions, particularly with lymph channel disruption.


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