Schistosomiasis: an unexpected finding in an inguinal hernia sac.

We report an 11-year-old boy who was diagnosed with schistosomiasis based on histopathologic examination of an inguinal hernia sac specimen. The child was an immigrant from Liberia and presented to our institution with inguinal and scrotal swelling. His past medical history was remarkable for previous ipsilateral hernia sac repair in West Africa, and at the time of his recurrent hernia repair, he was noted to have a peculiar loculated fluid-filled hernia sac, which was sent for pathologic examination because of its unusual appearance. Histologic examination revealed an intense infiltrate of eosinophils and numerous granulomas with ova of Schistosoma mansoni, and this speciation was confirmed with a stool wet prep examination for ova and parasites. Review of the English-language literature uncovered no prior cases of schistosomiasis presenting as an inguinal hernia. This unusual finding in a "routine" specimen, otherwise destined for the incinerator without pathologic evaluation, reinforces the importance of surgical vigilance in recognizing unusual or atypical features in these specimens.