A case of bilateral inguinal hernia recurrence in infancy: investigations on collagen metabolism.
BACKGROUND
Recurrent inguinal hernias in early infancy are rare. We report on a case of a 3-month-old male infant suffering bilateral inguinal hernia recurrence (RINGH). Due to previous observations of an altered collagen metabolism in hernia patients, a severe connective-tissue pathology in the infant was hypothesised.


METHODS
Hernial sac tissue of the infant was analysed and compared to specimens from five children operated upon one-sided primary inguinal hernias (controls). In paraffin-embedded sections, we determined the distribution of collagen types I and III by crosspolarisation microscopy and the expression of matrix metalloproteinase 2 (MMP-2) by immunohistochemistry. In fibroblast cultures, expression of collagen types I and III and of MMP-2 was investigated by RT-PCR (real-time polymerase chain reaction) and zymography. Electron microscopical investigations were performed exemplarily in two fibroblast cultures to compare cell morphology.


RESULTS
No differences in collagen I/III ratios between RINGH and controls were found either on protein or on mRNA level. Immunohistochemical and RT-PCR analysis of MMP-2 showed a lowered expression in the RINGH patient, as compared to controls, whereas the gelatinolytic activity of MMP-2 did not differ between the groups. Electron microscopical investigations showed similar cell arrangement and morphology.


CONCLUSIONS
To conclude, a marked biochemical correlate to a severe connective-tissue pathology in the infant suffering inguinal hernia recurrence could not be found. With regard to the slight differences in the expression of MMP-2, a possible role in the genesis of inguinal hernia recurrence cannot be ruled out.
Rosch
R
R
Department of Surgery, University Hospital Aachen, Germany. r.rosch@chir.rwth-aachen.de
Junge
K
K
Lynen
P
P
Stumpf
M
M
Steinau
G
G
Klinge
U
U
Schumpelick
V
V
D000015:Abnormalities, Multiple; D002478:Cells, Cultured; D003094:Collagen / Q000378:metabolism*; D005347:Fibroblasts / Q000378:metabolism / Q000648:ultrastructure; D006552:Hernia, Inguinal / Q000151:congenital* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000378:metabolism; D012008:Recurrence
D003094:Collagen; D020778:Matrix Metalloproteinase 2