PERITONEAL (MESOTHELIAL) SAC AND HERNIA FORMATION

PERITONEAL (MESOTHELIAL) SAC AND HERNIA FORMATION

The processus vaginalis refers to a peritoneal tube that advances into the inguinal ligament in tandem with migra tion of the testes. The lumen of the processus vaginalis is in continuity with the peritoneal cavity . Given this, it provides a conduit for herniation of abdominal contents. Even a residual indentation at the ostium of the processus v aginalis represents a mechanical defect at which repeated episodes of raised intraperitoneal pressure can lead to gradual extension of the parietal peritoneum into the inguinal canal. The mesothelial sac is a near constant feature of incisional and parastomal hernias. In these instances, the peritoneum gradually advances over subcutaneous fat, or the serosal sur face of the intestine, bringing that region of anatom y directly in continuity with the peritoneal cavity . Not surprisingly , inci sional or parastomal hernias gradually increase in size with time. In addition, they are frequently complicated by para stomal her niation of intestinal contents and intestinal com promise.