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Sujino H, Gon H, Shimoda Y, Takishita C, Enomoto M, Tachibana S, Kasuya K, Nagakawa Y. Incomplete bowel obstruction caused by sigmoid colon cancer in an inguinal hernia: a case report. Surg Case Rep 2024; 10:99. [PMID: 38656705 PMCID: PMC11043287 DOI: 10.1186/s40792-024-01874-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Most colon cancers that develop in the intestinal tract within the inguinal hernia sac are identified by incarceration. However, treatment methods for these cases vary depending on the pathology. Cases showing perforation or abscess formation require emergency surgery for infection control, while cases with no infection generally involve oncological resection, with laparoscopic surgery also being an option. We encountered a case of Incomplete bowel obstruction secondary to sigmoid colon cancer within the hernial sac. We report the process leading to the selection of the treatment method and the surgical technique, along with a review of the literature. CASE PRESENTATION A 79-year-old man presented to our hospital complaining of a left inguinal bulge (hernia) and pain in the same area. The patient had the hernia for more than 20 years. Using computed tomography, we diagnosed an incomplete bowel obstruction caused by a tumor of the intestinal tract within the hernial sac. Since imaging examination showed no signs of strangulation or perforation, we decided to perform elective surgery after a definitive diagnosis. After colonoscopy, we diagnosed sigmoid colon cancer with extra-serosal invasion; however, we could not insert a colorectal tube. Although we proposed sigmoid resection and temporary ileostomy, we chose the open Hartmann procedure because the patient wanted a single surgery. For the hernia, we simultaneously used the Iliopubic Tract Repair method, which does not require a mesh. Eight months after the surgery, no recurrence of cancer or hernia was observed. CONCLUSIONS We report a case of advanced sigmoid colon cancer with a long-standing inguinal hernia that later became incomplete bowel obstruction. Although previous studies have used various approaches among the available surgical methods for cancer within the hernial sac, such as inguinal incision, laparotomy, and laparoscopic surgery, most hernias are repaired during the initial surgery using a non-mesh method. For patients with inguinal hernias that have become difficult to treat, the complications of malignancy should be taken into consideration and the treatment option should be chosen according to the pathophysiology.
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Affiliation(s)
- Hiroki Sujino
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Hideki Gon
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Yota Shimoda
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Chie Takishita
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Masanobu Enomoto
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Shingo Tachibana
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Kazuhiko Kasuya
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan.
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan.
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
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Zhang J, Tang Y, Wu X, Wang G, Li T. Sigmoid Colon Cancer Masquerading as a Right Incarcerated Inguinal Hernia: A Case Study and Literature Review. Front Surg 2022; 9:832771. [PMID: 35252338 PMCID: PMC8891130 DOI: 10.3389/fsurg.2022.832771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background Indirect inguinal hernia and sigmoid colon cancer are both common diseases, but carcinoma within the hernia sac is rare. We present a case of sigmoid colon cancer masquerading as a right incarcerated inguinal hernia. Since such a presentation is rare, and the correct diagnosis is usually made intraoperatively, there is still no consensus on the best treatment modality for such patients. Case Presentation A 70-year-old man presented to our hospital on September 20, 2020, with a right inguinal mass that had been painful for half a month, accompanied by symptoms of difficult defecation. The bulge was originally found at least 60 years before admission. There was no pain at the time; however, the mass enlarged progressively during the last 3 years. The right scrotum and groin area were obviously enlarged (~20 × 20 cm) and tender. Inside the scrotum, a circumscribed medium-hard mass (diameter 5 cm) that was palpable, with ill-defined borders and translational mobility was detected. The computed tomography (CT) scan showed a right blood vessel-containing strangulated inguinal hernia; the sigmoid colon showed focal wall thickening as it was in proximity to the inguinal hernia. Based on the biopsy results, a pathologic diagnosis of high-grade intraepithelial neoplasia was made. The preliminary diagnosis was that of sigmoid carcinoma and right incarcerated inguinal hernia. Emergency laparoscopic exploration, open sigmoid radical resection andright inguinal hernia repair were performed under general anesthesia. The patient recovered successfully and was discharged 1 week after the operation. One month after surgery, no discomfort and signs of recurrence were found. Conclusions The combination of colorectal cancer and inguinal hernia is uncommon, and detailed preoperative physical examination and imaging studies may contribute to the establishment of a correct diagnosis. The selection of appropriate surgical methods ensures good therapeutic results.
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Affiliation(s)
- Jianfeng Zhang
- The Second Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yujie Tang
- School of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Xueliang Wu
- Department of General Surgery, The First Affiliated Hospital of Hebei North University, Shijiazhuang, China
| | - Guiying Wang
- Gastrointestinal Surgery Department, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Guiying Wang
| | - Tian Li
- School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
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Gerosa M, Incarbone N, Di Fratta E, Mari GM, Guttadauro A, Cioffi U, Maggioni D. Incarcerated sigmoid large-cell neuroendocrine carcinoma in an inguinal hernia. J Surg Case Rep 2021; 2021:rjaa585. [PMID: 33604019 PMCID: PMC7880701 DOI: 10.1093/jscr/rjaa585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/22/2021] [Indexed: 11/13/2022] Open
Abstract
Large-cell neuroendocrine carcinomas (NECs) of the colon are extremely rare aggressive tumors. A 79-year-old man presented at our hospital for muco-hematic diarrhea, weight loss and incarcerated hernia in his left groin. Colonoscopy revealed sigmoid stenosis. Computed tomography confirmed an incarcerated hernia containing sigmoid mass and massive abdominal adenopathy. In absence of colonic obstruction, the patient underwent elective palliative sigmoid resection and colostomy by laparoscopic approach, and direct hernia repair through inguinal access. Histopathological examination revealed a large cells sigmoid NEC. We report the first case of large-cell neuroendocrine colon cancer incarcerated in an inguinal hernia. Due to the advanced stage, we have performed a palliative laparoscopic resection in order to reduce surgical trauma, confirm pre-operative results and minimize post-operative complications, and direct hernia repair through inguinal access.
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Affiliation(s)
- Martino Gerosa
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
| | - Niccolò Incarbone
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
| | - Emanuele Di Fratta
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
| | - Giulio Maria Mari
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
| | - Angelo Guttadauro
- Department of Surgery, University of Milan Bicocca, Istituti Clinici Zucchi, Via Zucchi 24, Monza, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Via F. Sforza 35, Milan, Italy
| | - Dario Maggioni
- Laparoscopic and Oncological General Surgery Department, ASST Monza, Desio Hospital, Via Mazzini 1, Desio, Italy
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Kawai H, Haruki K, Takada N, Iino T, Ikegami M, Yanaga K. Small bowel adenocarcinoma incarcerated within an inguinal hernia. Surg Case Rep 2019; 5:205. [PMID: 31883032 PMCID: PMC6934635 DOI: 10.1186/s40792-019-0765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/20/2019] [Indexed: 11/17/2022] Open
Abstract
Background Small bowel adenocarcinomas are rare malignant tumors that account for less than 2% of gastrointestinal malignancies. In addition, tumor incarceration in an inguinal hernia is also rare entity. We herein report a first case of small bowel adenocarcinoma incarcerated within an inguinal hernia. Case presentation A 75-year-old man with asymptomatic anemia (hemoglobin, 8.6 g/dl) had a checkup at our hospital. Colonoscopy revealed bleeding through the ileocecal valve and an annular stricture by a tumor in the ileum. Endoscopic biopsy revealed a well-differentiated adenocarcinoma of the small bowel. Enhanced computed tomography showed a hypervascular solid tumor incarcerated within a right inguinal hernia. With a diagnosis of small bowel adenocarcinoma incarcerated within a right inguinal hernia, the patient underwent elective laparotomy with midline excision. The small bowel tumor, located at 30 cm from the terminal ileum, was incarcerated within a right inguinal hernia, and the small bowel was adherent to the hernia sac. A 24-cm segment of the distal ileum and regional lymph nodes were resected. The hernia sac was ligated, and the bottom of the hernia sac was resected. The hernia orifice was closed by tissue repair technique via a standard oblique incision in the right inguinal region. Postoperatively, the patient remains well with no evidence of tumor or hernia recurrence as of 1 year after operation. Conclusions We reported to our knowledge the first case of small bowel adenocarcinoma incarcerated within an inguinal hernia.
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Affiliation(s)
- Hironari Kawai
- Department of Surgery, The Saitama Jikei Hospital, 3-208, Ishihara, Kumagaya, Saitama, 360-0816, Japan. .,Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Koichiro Haruki
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Naoki Takada
- Department of Surgery, The Saitama Jikei Hospital, 3-208, Ishihara, Kumagaya, Saitama, 360-0816, Japan.,Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Toshio Iino
- Department of Surgery, The Saitama Jikei Hospital, 3-208, Ishihara, Kumagaya, Saitama, 360-0816, Japan.,Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masahiro Ikegami
- Department of Pathology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Daly D, Filgate R, Muhlmann M. Incarcerated inguinoscrotal hernia containing sigmoid colon cancer. ANZ J Surg 2016; 88:E550-E551. [PMID: 27018373 DOI: 10.1111/ans.13472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel Daly
- Department of General Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Rhys Filgate
- Department of General Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Mark Muhlmann
- Department of General Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
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Marsden M, Curtis N, McGee S, Bracey E, Branagan G, Sleight S. Intrasaccular caecal adenocarcinoma presenting as enlarging right inguinoscrotal hernia. Int J Surg Case Rep 2014; 5:643-5. [PMID: 25194594 PMCID: PMC4189051 DOI: 10.1016/j.ijscr.2014.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 06/24/2014] [Accepted: 07/14/2014] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Colorectal cancer and inguinal hernias are both common surgical pathologies in the elderly but rarely co-exist. Where the conditions overlap, there can be difficulties in both diagnosis and treatment. PRESENTATION OF CASE A 78 year old man with unexplained iron deficiency anaemia was investigated for gastrointestinal cancer. He was found to have enlarging bilateral inguinoscrotal hernias. CT colonoscopy revealed a herniated caecal carcinoma contained within the scrotum. An open excision was performed. DISCUSSION Iron deficiency anaemia without obvious bleeding is associated with colorectal cancer and should be thoroughly investigated. Asymptomatic inguinal hernias are often ignored by patients. However, a change in an existing hernia may be associated with neoplasia. CONCLUSION Dual pathology raises new difficulties in assessment, investigation and management of colorectal cancer.
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Affiliation(s)
- Max Marsden
- Department of Colorectal Surgery, Salisbury District Hospital, Odstock Road, Salisbury, Wilts SP2 8BJ, UK
| | - Nathan Curtis
- Department of Colorectal Surgery, Salisbury District Hospital, Odstock Road, Salisbury, Wilts SP2 8BJ, UK
| | - Shaun McGee
- Department of Radiology, Salisbury District Hospital, Odstock Road, Salisbury, Wilts SP2 8BJ, UK
| | - Emma Bracey
- Department of Colorectal Surgery, Salisbury District Hospital, Odstock Road, Salisbury, Wilts SP2 8BJ, UK
| | - Graham Branagan
- Department of Colorectal Surgery, Salisbury District Hospital, Odstock Road, Salisbury, Wilts SP2 8BJ, UK
| | - Simon Sleight
- Department of Colorectal Surgery, Salisbury District Hospital, Odstock Road, Salisbury, Wilts SP2 8BJ, UK.
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