Bilateral inguinal-scrotal hernia in a Cameroonian farmer exposed

Bilateral inguinal-scrotal hernia in a Cameroonian farmer exposed to heavy work
Hernie inguinale et scrotale bilatérale chez un maraîcher camerounais exposé au
travail lourd.
Francis Nde Djiele, Christophe De Brouwer.
École de Santé publique. Université Libre de Bruxelles. Belgique.
Adresse de correspondance:
Francis Nde.
École de Santé Publique, CP 593.
Campus Erasme.-, 808, route de Lennik. B-1070 Bruxelles.
Email: [email protected]
Summary
A 41 years old male farmer was interviewed in the frame of our clerkship as general practitioner in Cameroon.
He had 3 years of inguinal relapsing swollen groin history. He consulted a traditional practitioner few times,
without any improvement of his health condition. He never presented to a clinician.
A google scolar and medline search on quality of life and hernias led to few articles on the specific topic on this
rare condition.
There were impact on professional activity and social family life. When taking into consideration the unique
characteristic of such a situation in an informal worker, we offered to the worker to have counseling and a
surgery in a clinic, and a return to work with only progressive load activity.
We suggested that a general sensitization be carried out in farmers of informal sector, with information on
professional risks in Cameroon. J Int Santé Trav 2015;1:17-22.
Résumé :
Dans le cadre d’un stage en santé communautaire, un agriculteur de 41 ans a été interrogé au Cameroun. Il avait
des antécédents d’une tuméfaction dans la région inguinale, récidivantes depuis 3 ans, l’ayant amené à consulter
des tradi-praticiens à plusieurs reprises, sans amélioration des symptômes. Il n’avait jamais consulté un médecin
moderne.
Une recherche sur google scholar et sur medline au sujet des hernies et de la qualité de vie nous a conduit à des
articles spécifiques sur cette pathologie rare.
Nous avons observé des impacts sur l’activité professionnelle et sur la vie familiale de ce travailleur. Tenant
compte des caractéristiques particulières de ce travailleur du secteur informel dans le domaine maraîcher, nous
lui avons proposé une prise en charge par des conseils, suivis d’une opération chirurgicale, puis une reprise
progressive de son activité.
Nous avons suggéré qu’une sensibilisation générale soit faite à l’attention de tous les travailleurs maraîchers du
secteur informel au sujet des risques professionnels de manutention.
Key words: farmer, inguinal-scrotal hernia, informal sector, professional risk.
Mots-clé: maraîcher, hernie inguino-scrotale, secteur informel, risques professionnels.
Nde et al
Bilateral inguinal-scrotal hernia in a farmer
J Int Santé Trav 2015;1:17-22
Introduction.
Clinical question/problem
What can be the impact of untreated clinical inguinal-scrotal hernia on professional activity and social life
of a farmer? Risks take by a farmer due to lack of means to seek health care in a precarious situation.
Analysis of literature review
There is an evidence based relationship between work and health 1.
There is still strong seeking of traditional medicine in Black African populations despite the declaration of
Abuja on traditional practice2.
The high mortality related to hernias is directly related to the delayed recognition 3.
Inguinal hernias are one of the most common reasons a primary care patient may need referral for surgical
intervention. The history and physical examination are usually sufficient to make the diagnosis 4.
Méthode
1/ Une recherche sur google scholar et sur medline au sujet des hernies et de la qualité de vie nous a
conduit à des articles spécifiques sur cette pathologie rare.
Résultat
Nous avons observé des impacts sur l’activité professionnelle et sur la vie familiale de ce travailleur.
Tenant compte des caractéristiques particulières de ce travailleur du secteur informel dans le domaine
maraicher, nous lui avons proposé une prise en charge par des conseils, suivis d’une opération
chirurgicale, puis une reprise progressive de son activité.
Conclusion
Nous avons suggéré qu’une sensibilisation générale soit faite à l’attention de tous les travailleurs
maraichers du secteur informel au sujet des risques professionnels de manutention.
Case history/report:
A. Description of patient
A 41 years old male was interviewed during our survey on farmer’s work in Cameroon, in a village close
to Douala city in 2012. The patient presented a complaint of testis swelling.
B. History of presenting condition
History of the disease reveals that the patient has this swelling since 4 years. At the beginning, it was a
returning mass, which started appearing on the left side as he was farming. Later on, the wright side
started being involved. He used to push back the swelling as it appeared. But later, he could no longer
push it back. But since it wasn’t “that much” handicapping, and he did not have enough money to present
to the hospital, he could “manage” with the situation. His activity was slowed down and he could no
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Nde et al
Bilateral inguinal-scrotal hernia in a farmer
J Int Santé Trav 2015;1:17-22
longer have proper intercourse with his wife, but although his family life and professional activities were
compromised, he had no option than continue working.
We offered him a consultation with a general practitioner. On admission he had a normal apparent general
state.
The hernia could obviously be seen as in the figure below.
Blood pressure was normal 130/80 mmHg and heart rate 78 bits per minute. He had no fever.
Abdominal X ray was done; Ultrasound was also performed and showed presence of intestines in the
testis sac.
The patient was immediately scheduled for surgery.
A pre operatory assessment was done with the routine checking in blood.
The patient was operated successfully and spent a 10 days post operation hospitalization without any
complication.
Literature search
After a “medline” and “google scholar” research, with the terms “hernia”, “giant bilateral hernia”,
“inguinoscrotal hernia”, “heavy work”, we found few articles on the subject.
Results of search (# relevant, citations, what you learned)
We found about a dozen of relevant articles treating the issue. Few are mentioned under the subtitle
“analysis of literature”.
Discussion (significance, why you’re writing this)
This case is triggered by the fact that in developing countries, especially in this case in Cameroon, most
of the farmers in poor resource settings are involved in heavy physical activities, and exposed to several
health complications, but have either no money, or no time to seek medical care. On the other hand,
appropriate health coverage may lack, making the situation more complicated. In the present case, the
worker is in a category of profession that takes a great part in the economy of the country as “informal
sector workers”, yet his health status is precarious.
A. Relevant literature
Although musculoskeletal symptoms such as lower back pain seems to be common in manual handling
workers5, literature also reports bilateral giant inguinal-scrotal hernias, a condition that does not only pose
challenging psychosocial problems to the patient 6, but may lead to serious complications unless operated
in some cases7. This disease is not the proper of only developing countries, but is still found in Western,
with all the possible complications that could occur in case it is not operated emergently 8. Although this
condition could be congenital 9,10 there are known causes related to heaviness of work, that raises intraabdominal pressure11. Another important aspect of professional consequence of such a situation is anxiety
that could be caused by the impact of this condition, due to lack of sexual intercourse. The relationship
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Bilateral inguinal-scrotal hernia in a farmer
J Int Santé Trav 2015;1:17-22
between the two is reported by Khashdan et al. 12. Such a case from farmers in informal sector worker has
never been reported before. Delay in diagnosis may lead to complications both professional and social.
This delay may reach up to 51 years in some cases2. Economic crisis plays a great role in risk taken by
workers in developing countries, leading to delay in management1, meanwhile early diagnosis and repair
has always been recommended as strategy in patient of all age by specialists 13. Our case reported to us
that he had no enough financial means to seek health care form a clinician. On the other hand, there are
strong local though that traditional practitioners have health solutions to such diseases that look unusual
to local population, with a though of non-natural condition connotation. Indeed, our famer had already
consulted a traditional practitioner for care. Local proximity may also justify such an attitude.
B. Hypothesis
Health related problem may lead to alteration in professional activity and impaired social life with a back
consequence on professional activity in farmer’s workers of informal sector in poor resource setting.
C. Diagnostic process/course of illness
Table of diagnostic process
Inguinal hernias are one of the most common reasons a primary care patient may need referral for surgical
intervention. The history and physical examination are usually sufficient to make the diagnosis
Figure1. Huge groin swollen hernia on the farmer.
D. Outcomes
The patient was eventually operated through elective surgery and spent 10 days post operation at hospital,
without any complication.
It was recommended that he starts working avoiding heavy load for six months in order to avoid relapse.
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Nde et al
Bilateral inguinal-scrotal hernia in a farmer
J Int Santé Trav 2015;1:17-22
Conclusions/recommendations (lesson learned)
Few lessons were: Rare disease can be found in farmers of informal sector, with working and private life
complications. The association between impaired health and professional life as well as social life is also
consistent with suggestion of literature in similar setting.
These workers are exposed to health difficulties and have less access to health care system, due to lack of
means and some times, poor sensitization on complications
A better coverage could lead to early diagnosis of sickness of these workers and avoidance of possible
complication of their illness.
Sensitization is necessary on risks in farmers of the informal sector in Cameroon.
Conflict of interest
None
References
1 Tomasina F. Problems of work world and its impact on health. Current financial crisis. Rev Salud
Publica (Bogota). 2012 Jun;14 Suppl 1:56-67.
2 News l Inter Afr Comm Tradit Pract Affect Health Women Child. Abuja declaration calls for action
against hazardous traditional practices. 1990 May;(9):13-4.
3 Chang SS, Shan YS, Lin YJ, Tai YS, Lin PW. A review of obturator hernia and a proposed algorithm
for its diagnosis and treatment. World J Surg. 2005 Apr;29(4):450-4.
4 LeBlanc KE, LeBlanc LL, LeBlanc KA. Inguinal hernias: diagnosis and management. Am Fam
Physician. 2013 Jun 15;87(12):844-8.
5 Yeung SS, Genaidy A, Deddens J, Alhemood A, Leung PC. Prevalence of musculoskeletal symptoms in
single and multiple body regions and effects of perceived risk of injury among manual handling workers.
Spine (Phila Pa 1976). 2002 Oct 1;27(19):2166-72.
6 Akpo EE. Bilateral giant inguinoscrotal Hernia: psychosocial issues and a new classification. Afr
Health Sci. 2013 Mar;13(1):166-70. doi: 10.4314/ahs.v13i1.24.
7 Góngora-Gómez EM. Strangulated inguinal hernia. Cir Cir. 2012 Jul-Aug;80(4):357-67.
21
8 Gaedcke J, Schüler P, Brinker J, Quintel M, Ghadimi M. Emergency repair of giant
inguinoscrotal hernia in a septic patient. J Gastrointest Surg. 2013 Apr;17(4):837-9. doi:
10.1007/s11605-012-2136-7. Epub 2013 Jan 9.
9 Kelly KB, Ponsky TA. Division of Pediatric Surgery, Pediatric Surgery Center, Akron
Children's Hospital, One Perkins Square, Akron, OH 44308, USA. The Surgical Clinics of North
America [2013, 93(5):1255-1267] .
10 Hendry PO, Paterson-Brown S, de Beaux A. Work related aspects of inguinal hernia: a
literature review. Surgeon. 2008 Dec;6(6):361-5.
11 Zhou TC, Yang B, Zhang YC, Zhang L, Chen S. Study on intra-abdominal pressure in indirect
inguinal hernia patients. Zhonghua Wai Ke Za Zhi. 2007 Nov 1;45(21):1455-7.
12 Kashdan TB, Adams LM, Farmer AS, Ferssizidis P, McKnight PE, Nezlek JB. Sexual
Healing: Daily Diary Investigation of the Benefits of Intimate and Pleasurable Sexual Activity in
Socially Anxious Adults. Arch Sex Behav. 2013 Aug 28.
13 Oishi SN, Page CP, Schwesinger WH. Complicated presentations of groin hernias. Am J Surg.
1991 Dec;162(6):568-70.
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