Pediatric direct inguinal hernia is a rare entity, and the coexistence of ipsilateral indirect and direct inguinal hernias (pantaloon hernia) is even more uncommon. Consequently, pediatric surgeons have limited experience with this entity. We report a 12-year-old boy who presented with a reducible right inguinal mass. Laparoscopy revealed a right-sided pantaloon hernia (predominantly indirect) and a contralateral patent processus vaginalis on the left. We performed transumbilical single-port laparoscopic bilateral high ligation of the hernia sacs (including both the direct and indirect components on the right) combined with reinforcement using the right medial umbilical ligament. The procedure was uneventful, and the patient was discharged on postoperative day 1. At 6-month follow-up, no recurrence, pain, or groin infection were observed, and the cosmetic outcome was excellent with minimal scarring. We believe that laparoscopy offers unique advantages in pediatric inguinal hernia repair by enabling accurate identification of "atypical" hernias, reducing missed diagnoses, and allowing contralateral exploration to decrease the risk of metachronous hernias, thereby minimizing unnecessary surgical and anesthetic risks as well as financial burden. We share our experience to provide an alternative therapeutic option.

A hernia is the protrusion of an organ, such as the bowel, through the lining wall of the cavity in which it normally resides. Pediatric hernias are common developmental abnormalities which have different etiopathogenesis as well as management as compared to adults. Presence of persistent processus vaginalis is common mechanism in the etiopathogenesis of indirect inguinal hernia and hydrocele in children. Right sided hernias more common than left since, as , left processus vaginalis obliterates before the right. Author is reporting here a case of recurrent inguinoscrotal hernia with hydrocele in a child and its management.

A hydrocele is an abnormal collection of serous fluid between the two layers of tunica vaginalis of testis.[1] It can either be congenital or acquired. Congenital hydrocele results from failure of processus vaginalis to obliterate. During development, the testes are formed retroperitoneally in the abdomen and proceed to descend into the scrotum via the inguinal canal in the third gestational week. This descent of the testes into the scrotum is accompanied by a fold of peritoneum of the processus vaginalis. Normally, the proximal portion of processus vaginalis gets obliterated while the distal portion persists as the tunica vaginalis covering the anterior, lateral, and medial aspects of the testes. The tunica vaginalis is a potential space for fluid to accumulate, provided the proximal portion of processus vaginalis remains patent and results in free communication with the peritoneal cavity, leading to congenital hydrocele.[2] Hydroceles are divided into two types: primary and secondary. Primary Hydrocele: The processus vaginalis of the spermatic cord fuses at term or within 1-2 years of birth, thus obliterating the communication between the abdomen and scrotum. The distal portion, however, remains patent as the tunica vaginalis covers the testis, creating a potential space where fluid accumulation within it can lead to hydrocele formation. Depending upon the site of the obliteration of processus vaginalis, there are four types of primary hydrocele.1. Congenital Hydrocele: This occurs when processus vaginalis is patent and communicates with the peritoneal cavity. This communication allows the movement of peritoneal fluid but is too small to allow the intra-abdominal contents to herniate through.2. Infantile Hydrocele: In this case, processus vaginalis gets obliterated at the level of the deep inguinal ring. However, the portion distal to it remains patent and allows fluid accumulation.3. Encysted Hydrocele of the Cord: Both the proximal and distal portions of processus vaginalis get obliterated while the central portion remains patent and fluid accumulates within it.4. Vaginal Hydrocele: Processus vaginalis remains patent only around the testes, and, as fluid accumulates, it renders the testes impalpable. Secondary Hydrocele: This usually occurs as a result of an underlying condition, such as infection (filariasis, tuberculosis of the epididymis, syphilis), injury (trauma, post-herniorrhaphy hydrocele), or malignancy. This type of hydrocele tends to be small, with the exception of secondary hydrocele due to filariasis, which can be very large.

Chikungunya virus infection is considered to confer prolonged immunity. During the 2024-2025 outbreak in Reunion Island, we identified a confirmed and a probable reinfection in patients with systemic lupus erythematosus. These findings challenge this paradigm, underly a complex pathophysiology, and suggest that reinfection may occur, particularly in specific populations.

Extant turtles occupy freshwater, marine, and terrestrial habitats, and their nasal region provides important evidence for the evolution of respiration- and sensory-related cranial morphology. However, developmental data on the turtle nasal capsule remain limited, particularly in Pleurodira. Here, we describe nasal capsule development in the pleurodiran turtle Emydura subglobosa based on histological cross-sections of five distinct developmental stages and three-dimensional reconstructions. The nasal capsule underwent marked reorganization between Emyd. subglobosa developmental stages 4- and 5- (ES 4- and ES 5-), during which its basic architecture became established. Several features are notable. First, the nasal entrance shows distinctive pleurodiran specializations, including a processus supranarinus communis formed by medial fusion of the paired processus supranarini and a dorsally projecting processus rostralis medialis formed from the paired processus infranarini. In addition, Emyd. subglobosa possesses a fenestra rostralis at the nasal entrance, a feature not identified in other turtles examined to date. Second, the floor of the nasal capsule exhibits the expanded solum nasi complex characteristic of turtles, including the lamina transversalis anterior, pars paraseptalis, and pila supraglandularis, together with a canalis praepalatinus and a posteriorly facing fenestra basalis. Third, the pars ectochoanalis differs between the two major turtle clades: in pleurodires, it extends only slightly caudally, whereas in cryptodires it typically extends farther caudally and forms the ventral margin of the ductus nasopharyngeus. These findings provide a developmental framework for interpreting pleurodiran nasal morphology and a broader comparative framework for understanding turtle nasal evolution.

Benign recurrent intrahepatic cholestasis (BRIC) is a rare inherited cholestatic disorder whose diagnosis is usually confirmed by genetic testing. However, access to molecular diagnostics remains limited in many low- and middle-income countries. Here, we report a 38-year-old Cambodian man presenting with his first episode of severe cholestatic jaundice and pruritus. Extensive investigations excluded infectious, autoimmune, metabolic, and obstructive causes. Liver biopsy reviewed by a French expert reference center demonstrated isolated cholestasis, supporting the diagnosis of BRIC despite the absence of genetic confirmation. The patient achieved complete clinical and biochemical remission during follow-up. This case illustrates that BRIC can be diagnosed with high confidence using established clinical criteria when genetic testing is unavailable and highlights the value of international collaboration in improving rare disease diagnosis in resource-limited settings.

Meconium periorchitis is an uncommon but well-documented phenomenon by which intra-abdominal meconium reaches the scrotum via a patent processus vaginalis. This classically presents in a child first as a soft hydrocele, and later as a firm scrotal mass once calcification of the meconium occurs. We report a case of a 6-month-old boy with exam findings suspicious for perinatal testicular torsion who was taken for surgical exploration and found to have a meconium fecalith located inferior to the testicle and outside of the tunica vaginalis within the gubernaculum. The fecalith was excised and orchidopexy was performed. Meconium periorchitis needs to be considered in the differential diagnosis of pediatric scrotal masses. Overlooking this often-benign condition may lead to unnecessary surgery, potentially resulting in compromise of the testicle due to deliberate removal or unintended iatrogenic injury.

Abdominoscrotal hydrocele (ASH) is a rare variant of hydrocele characterized by contiguous scrotal and abdominal fluid collections communicating through the inguinal canal. Its pathogenesis remains poorly understood, and the available evidence is derived primarily from case reports and small retrospective case series, leaving continued uncertainty over its diagnosis, timing of intervention, and operative strategy. This narrative review summarizes and critically discusses the current literature on the pathogenesis, clinical presentation, imaging evaluation, differential diagnosis, and management of pediatric ASH. In children presenting with an apparently simple hydrocele, an unusually large, tense, or progressively enlarging inguinoscrotal swelling, ipsilateral lower abdominal fullness, or cross-fluctuation should prompt ultrasonographic assessment extending from the scrotum through the inguinal canal. Direct demonstration of continuity between the scrotal hydrocele and an abdominal fluid collection supports the diagnosis of ASH. Magnetic resonance imaging may be useful when the proximal extent or anatomical origin of the lesion remains unclear. Proposed mechanisms include pressure-driven cephalad extension of a scrotal hydrocele and persistent patency of the processus vaginalis, although neither mechanism fully accounts for all reported cases. Observation may be appropriate in carefully selected asymptomatic infants with close follow-up, whereas progressive, symptomatic, compressive, or diagnostically uncertain lesions generally warrant surgical intervention. Inguinal, scrotal, and laparoscopic approaches are all feasible, but the available evidence does not demonstrate the superiority of any single technique. Multicenter studies with standardized diagnostic criteria and long-term outcome reporting are needed to inform risk-stratified management.

The nasofrontal region of mammals is generally characterized by direct contact between the paired nasal bones and the frontal bone. However, detailed spatial relationships among the frontal bone, nasal bones, and osseous nasal septum remain insufficiently documented in bats. This study investigated the three-dimensional organization of the nasofrontal complex in the brown long-eared bat (Plecotus auritus) using high-resolution micro-computed tomography. Ten adult skulls were analyzed using three-dimensional reconstructions and multiplanar image analysis. A consistent and previously undescribed organizational pattern was identified in all specimens. Its principal feature was a median rostral extension of the frontal bone, designated processus internasalis ossis frontalis (nova structura), which projected between and separated the caudal portions of the paired nasal bones. This structure was consistently associated with ala ossis nasalis (nova structura), facies parasagittalis ossis nasalis (nova structura), a pronounced internasal sagittal impression, and a close topographical relationship with the osseous nasal septum. Together, these features constitute an integrated morphological complex rather than isolated anatomical modifications. The observed arrangement differs from the generalized mammalian condition, in which the paired nasal bones maintain direct median contact at the nasofrontal boundary. These findings reveal a distinct pattern of nasofrontal organization in P. auritus and demonstrate the value of high-resolution micro-computed tomography for identifying previously unrecognized aspects of mammalian cranial anatomy.