title: Multiple concurrent bilateral groin hernias in a single patient; a case report and a review of uncommon groin hernias: A possible source of persistent pain after successful repair.
abstract: BACKGROUND
  The wide use of laparoscopy for groin hernia repair has unveiled "hidden hernias" silently residing in this area. During the open repair of the presenting hernia, the surgeon was often unaware of these occult hernias. These patients postoperatively may present with unexplained chronic groin or pelvic pain.
  
  
  METHODS
  Rare groin hernias are defined according to their anatomical position. Challenges in the diagnosis and management of occult rare groin hernias are discussed. These problems are illustrated by a unique case report of multiple (six) coexisting groin hernias, whereof five were occult and two were rare.
  
  
  CONCLUSIONS
  Rare groin hernias are uncommon because they are difficult to diagnose clinically and are not routinely looked for. They are often occult and may coexist with other inguinal hernias, thus posing a diagnostic and treatment challenge to the surgeon, especially if there is persistent groin pain after "successful" repair. MRI is the most accurate preoperative and postoperative diagnostic tool, if there is a clinical suspicion that the patient might have an occult hernia.
  
  
  CONCLUSIONS
  Preperitoneal endoscopic approach is the recommended method in confirming the diagnosis and management of occult groin hernias. A sound knowledge of groin anatomy and a thorough preperitoneal inspection of all possible sites for rare groin hernias are needed to diagnose and repair all defects. The preperitoneal mesh repair with adequate overlap of all hernia orifices is the recommended treatment of choice.
authors.affiliation: Department of Surgery, Sefako Makgatho Health Sciences University, Dr George Mukhari Academic Hospital, Pretoria, South Africa. Electronic address: info@matsevych.com.
authors.forename: O Y
authors.initials: OY
authors.lastname: Matsevych
authors.affiliation: Department of Surgery, Sefako Makgatho Health Sciences University, Dr George Mukhari Academic Hospital, Pretoria, South Africa. Electronic address: zachkoto@gmail.com.
authors.forename: M Z
authors.initials: MZ
authors.lastname: Koto
authors.affiliation: Department of Surgery, Sefako Makgatho Health Sciences University, Dr George Mukhari Academic Hospital, Pretoria, South Africa. Electronic address: jhr.becker@telkomsa.net.
authors.forename: J H R
authors.initials: JHR
authors.lastname: Becker
keywords: Laparoscopic preperitoneal mesh repair; Multiple groin hernias; Occult groin hernia; Rare groin hernia