Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 77241

AbstractCase ReportDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Case report
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : YD04 - YD06 Full Version

Physical Rehabilitation of Patient with Infrarenal Abdominal Aortic Aneurysm Presenting with Hydrocele and Inguinal Hernia: A Case Report

Published: June 1, 2023 | DOI:
Dhanush Kotian, Abeeshna Ashok

1. Postgraduate Student, Nitte Institute of Physiotherapy, NITTE (Deemed to be University), Deralakatte, Mangalore, Karnataka, India. 2. Assistant Professor, Nitte Institute of Physiotherapy, NITTE (Deemed to be University), Deralakatte, Mangalore, Karnataka, India.

Correspondence Address :
Dr. Abeeshna Ashok,
Assistant Professor, Nitte Institute of Physiotherapy, NITTE (Deemed to be University), Deralakatte, Mangalore-575018, Karnataka, India.


Infrarenal Abdominal Aortic Aneurysm (AAA) is an abnormal dilation of distal abdominal aorta. The risk factors are age older than 60 years, smoking, hypertension and caucasian ethnicity. Testicular pain is an uncommon clinical presentation. There is a high prevalence of inguinal hernia in patients with infrarenal AAA. The purpose of the present case report is to describe the functional activity limitation in a patient affected by an infrarenal AAA presenting as a symptom of inguinal hernia and groin pain despite successful infrarenal AAA repair with aortofemoral bypass surgery and bilateral inguinal hernia repair. A 62-year-old male patient, presented with pain in the groin region and mild swelling over the scrotal region, which was severely limiting his activities of daily living. A Computerised Tomography (CT) angio abdomen revealed a fusiform aneurysm on the distal abdominal aorta and a saccular aneurysm of bilateral common iliac arteries. Given the minimum of four days of referral waiting time to receive treatment for infrarenal AAA, the patient underwent surgery and was followed by the postoperative physiotherapy intervention. The rehabilitation programme started five days postsurgery. The treatment goals directed mainly decreasing postoperative pulmonary complications and improving functional mobility. The present case report contributes new light on the possible pathogenesis and timely management. It reports the unexpected and unusual presentation of the disease and unveiling the link between the presentation of infrarenal AAA and inguinal hernia and hydrocele.


Aortogram, Aneurysm, Physical therapy

Case Report

A 62-year-old male patient was referred to the Department of Physiotherapy by cardiothoracic and vascular surgery unit on Postoperative Day (POD) 5. The chief complaint was pain, over the abdominal surgical incision site along with the movement restriction in the lower limb. The pain was sudden in onset, gradually progressive, dull aching type. The pain was aggravating during activity and patient also reported pain intensity score of seven on Numerical Pain Rating Scale (NPRS). The patient also presented with swelling in the lower limb and scrotum as well. He was overweight, with a Body Mass Index (BMI) of 28.6 kg/m2. The history revealed that, the patient was in his usual state of health five months ago, when he had pain in his groin region and also noticed mild swelling over the scrotal area. The pain was sudden in onset and gradually progressive, limiting his activities of daily living. The patient was stable and refused to consult the physician. An increase in pain severely affected the patient’s functional mobility. Then the patient consulted a nearby local hospital, where the physician advised him for a CT scan. The result demonstrated an infrarenal AAA along with the bilateral inguinal hernia and right-sided hydrocele. The physician recommended better care for the patient, and was referred to a multispeciality hospital for further management. As per the suggestion, the patient visited the hospital, where transthoracic echocardiography was done before the surgery, which demonstrated mild left ventricular dysfunction with an Left Ventricular Ejection Fraction (LVEF) of 45%. The aneurysm repair was delayed for three days after the admission to the hospital due to fluctuations in blood pressure. After the vitals were normalised, the surgeons opted for infrarenal AAA repair with aortobifemoral bypass surgery and bilateral inguinal hernia repair.

The surgeons could not perform a hydrocelectomy since, the vitals were unstable. The surgery was performed on the 4th day of hospital admission. Postoperatively the patient got shifted to the postoperative care unit, with an unstable blood saturation level of 80%. The patient was on 6 L of supplemental oxygen and weaned off from the nasal cannula on POD 5 since, the patient maintained an oxygen saturation level of 97%. As the condition was resolving and the patient was symptomatically improving and got shifted to the ward. As per the surgeon’s order, the physiotherapy assessment and management were started on the same day in the ward.

The surgical history revealed that, the patient underwent Percutaneous Transluminal Coronary Angioplasty (PTCA) to Left Anterior Descending artery (LAD) 20 years ago. Then, the patient continued anticoagulants only for four years and stopped the medication afterward without any medical advice. And again, he underwent Coronary Artery Bypass Grafting (CABG) surgery with three grafts a year ago. Patient is currently under statins and antacids and had had stopped smoking and alcohol consumption 20-year-ago after the PTCA surgery.

Clinical Findings

On observation, the chest findings revealed that, the patient had thoracoabdominal breathing pattern and there was a healed sternotomy surgical scar present. The abdominal findings are midline abdominal incision, incision over the paraumbilical region and swelling of the scrotum. There was a surgical incision present over the left groin region, healed surgical incision scar and oedema present over the left lower limb. On examination, the chest findings showed normal chest symmetry and the length of the sternotomy incision is 32 cm measured using an inch of tape. The length of the surgical incision scar on the left leg measures about 33 cm, non pitting oedema over the left lower limb. Normal breath sounds heard on pulmonary auscultation. S1 and S2 were present on cardiac auscultation. The girth measurements are given in (Table/Fig 1). To get a clearer picture of the lesion, the patient underwent a CT angio abdomen before surgery, which demonstrated a fusiform aneurysm of the distal abdominal aorta (Table/Fig 2) and X-ray demonstrating left-sided hydrocele with the marked swelling (Table/Fig 3). CT aortogram showing saccular aneurysm of bilateral common iliac arteries and infrarenal abdominal aortic artery aneurysm (Table/Fig 4). CT angiogram showing fusiform aneurysm of the distal abdominal aorta (Table/Fig 5).

Physiotherapy Intervention

The acute rehabilitation comprised of the following objectives such as, maintenance of the range of motion and strength of the affected limb, preventing postoperative pulmonary complications, and recovery of standing position and walker training with walker support. The patient received physical therapy rehabilitation from POD 5 till discharge (for seven days). The treatment programme consisted 30 minute sessions, each consisting of 15 minutes of exercise in bed (1st session) and 15 minutes of gait training with assistance until discharge from the hospital (2nd session) (1). On the 5th day, static breathing exercises, incentive spirometry exercises, general relaxation exercises, and general light small muscle training exercises were given, and later, dynamic breathing exercises, physical exercises for medium size and large muscle, and walking with assistance was provided.

The programme usually started with cautious active mobilisation of the joints in the limb with the patient lying supine. Once the ankle joint had been mobilised, the knee and hip were often kept in flexed attitude because of the pain. Then, assisted active flexion and extension of the limb and stretched the hamstrings to gain complete knee extension. From the supine position, the patient was brought into lateral decubitus and then into a sitting place. From the 2nd session after 15 minutes of exercise in bed, the programme focused on the recovery of the upright position and gait. An upright position and gait training were usually aided with walker support. In the beginning, the patient was asked to walk for a 10 metre distance (Table/Fig 6). The patient performed longer distances progressively. (Table/Fig 7) shows the outcome measures taken pre and post physiotherapy management (2),(3),(4),(5). Barthel index showed 30% increase in the score and there was 30% decrease in both anxiety and depression components of Hospital Anxiety and Depression Scale (HADS). The pain intensity shown reduction of 28.6% and 50% on activity and on rest, resprectively. There was 100% decrease in dyspnoea on Borg dyspnoea scale (5).

The patient got discharged two week after the surgery. The patient was symptomatically better at the time of discharge and patient was asked to come for the review after three months for the fitness evaluation for hydrocelectomy. Home advices such as deep breathing exercises, posture correction exercises, ambulation training, upper limb and lower limb strengthening exercises with available weights and general awareness on physical activity were given.


An aneurysm is an abnormal dilation and weakening of an area of the arterial vessel this leads to tearing and haemorrhage into the wall (i.e., dissection) or surrounding tissue (i.e., rupture). An aortic aneurysm often presents as an acute dissection or rupture without any prior symptoms (1). Studies utilising the help of ultrasound screening revealed that, 4%-8% of the male geriatric population have an occult AAA. Ruptured aneurysms have a fatality rate of 50% to 95%, accounting for the 10th leading cause of death in men older than 55 years (6). They are usually present with the AAA the infrarenal portion of the abdominal aorta and just proximal to the distal portion of the iliac arteries. Inguinal hernia is a common clinical entity that presents along with the AAA. Elastin and collagen fiber abnormalities and disorders play a major role in this. Variations in the levels of collagenase, elastase, and antiproteases are important mechanisms in the pathophysiology of both diseases (7). Hydrocele is defined as, an abnormal collection of serous fluid in the space between the parietal and visceral layers of the tunica vaginalis, termed the cavum peritoneum scroti. Hydrocele is the most common cause of painless nonacute scrotal swelling in men and the normal scrotum contains about 2-3 mL of fluid between the tunics layers (8).

The described mortality rate of patients with a ruptured AAA is, as high as, 90%. In contrast, mortality rates for patients undergoing elective AAA repair are typically less than 10%. Accordingly, it is important to diagnose AAA before rupture (9). It is estimated that, 4% to 8% of men and 0.5% to 2% of women older than age 60 years have AAA. Larger aneurysms have an associated higher risk of rupture. In addition, larger aneurysms expand at a faster rate than smaller aneurysms. A 5 cm aneurysm has a predictable 20% annual risk of rupture and 6 cm aneurysm has an predictable 40% annual risk of rupture (10). When symptoms are produced they typically include deep, boring pain in the abdomen, pain, tenderness on palpation, and a prominent pulsating mass in the abdomen (11),(12). The functional abilities of the patient is found to be better with current rehabilitation protocol (13). Literature suggests that, there are no conservative management available to treat abdominal aortic aneuysm and the role of phyical therapy mainly comes in the education of risk factor prevention, cessation of smoking, signs and symptoms and public education. Preoperative phyical therapy management has shown improvement in postoperative outcome. Postoperative management should focus on the prevention of postoperative complications and early mobilisation (14),(15).

The present case report suggests that, an abdominal aneurysm can have many other presentations because of the compression on the surrounding structures such as bilateral groin pain, as well as, testicular pain and also, the report gives the new insight into the barriers in the management.


The authors would like to conclude by saying that, an infrarenal AAA can present as an inguinal hernia and hydrocele. Inguinal hernia and hydroceles are both characterised by swelling of the groin and scrotum. Hence, early physiotherapy intervention such as pulmonary rehabilitation and mobilisation helps in faster recovery of the patient undergoing AAA repair and bilateral inguinal hernia repair.


Ehrman JK, Fernandez AB, Myers J, Oh P, Thompson PD, Keteyian SJ. Aortic aneurysm: Diagnosis, management, exercise testing, and training. Journal of Cardiopulmonary Rehabilitation and Prevention. 2020;40(4):215-23. [crossref][PubMed]
Uchinaka EI, Hanaki T, Morimoto M, Murakami Y, Tomoyuki M, Yamamoto M, et al. The Barthel Index for predicting postoperative complications in elderly patients undergoing abdominal surgery: A prospective single-center study. In vivo. 2022;36(6):2973-80. [crossref][PubMed]
Tomee SM, Gebhardt WA, De Vries JP, Hamelinck VC, Hamming JF, Lindeman JH. Patients’ perceptions of conservative treatment for a small abdominal aortic aneurysm. Patient Prefer Adherence. 2018;15(12):119-28. [crossref][PubMed]
Tanaka A, Al-Rstum Z, Leonard SD, Bri’Ana DG, Yazij I, Sandhu HK, et al. Intraoperative intercostal nerve cryoanalgesia improves pain control after descending and thoracoabdominal aortic aneurysm repairs. The Annals of Thoracic Surgery. 2020;109(1):249-54. [crossref][PubMed]
Nolan CM, Kaliaraju D, Jones SE, Patel S, Barker R, Walsh JA, et al. Home versus outpatient pulmonary rehabilitation in COPD: A propensity-matched cohort study. Thorax. 2019;74(10):996-98. [crossref][PubMed]
Chu EC. Large abdominal aortic aneurysm presented with concomitant acute lumbar disc herniation-a case report. Journal of Medicine and Life. 2022;15(6):871. [crossref][PubMed]
Megalopoulos A, Ioannidis O, Varnalidis I, Ntoumpara M, Tsigriki L, Alexandris K, et al. High prevalence of abdominal aortic aneurysm in patients with inguinal hernia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2019;163(3):247-52. [crossref][PubMed]
Carlisi E, Caspani P, Morlino P, Bardoni MT, Lisi C, Bejor M, et al. Early rehabilitative treatment after mfraingurnal lower limb bypass surgery. Acta Bio Medica: Atenei Parmensis. 2017;88(2):167.
Clancy K, Wong J, Spicher A. Abdominal aortic aneurysm: A case report and literature review. The Permanente Journal. 2019;23:18.218. [crossref][PubMed]
Keisler B, Carter C. Abdominal aortic aneurysm. Am Fam Physician. 2015;91(8):538-43.
Fink HA, Lederle FA, Roth CS, Bowles CA, Nelson DB, Haas MA. The accuracy of the physical examination to detect abdominal aortic aneurysm. Arch Intern Med. 2000;160(6):833-36. Doi: [crossref][PubMed]
Chukwubuike KE. Complicated inguinal hernia in children: An experience in a developing country. J Med Sci. 2020;6(1):01-03. [crossref]
Rapsang AG, Shyam DC. Scoring systems in the intensive care unit: A compendium. Indian Journal of Critical Care Medicine: Peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2014;18(4):220. [crossref][PubMed]
Myers J, Mcelrath M, Jaffe A, Smith K, Fonda H, Vu A, et al. A randomized trial of exercise training in abdominal aortic aneurysm disease. Medicine and Science in Sports and Exercise. 2014;46(1):02-09. [crossref][PubMed]
Pouwels S, Willigendael EM, Van Sambeek MR, Nienhuijs SW, Cuypers PW, Teijink JA. Beneficial effects of pre-operative exercise therapy in patients with an abdominal aortic aneurysm: A systematic review. European Journal of Vascular and Endovascular Surgery. 2015;49(1):66-76.[crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/62943.18081

Date of Submission: Jan 18, 2023
Date of Peer Review: Feb 07, 2023
Date of Acceptance: Apr 19, 2023
Date of Publishing: Jun 01, 2023

• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Jan 19, 2023
• Manual Googling: Feb 14, 2023
• iThenticate Software: Mar 03, 2023 (18%)

ETYMOLOGY: Author Origin


JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)