Colonic carcinoma presenting as strangulated inguinal hernia: report of two cases and review of the literature

Strangulated Sliding Inguinoscrotal Hernia with a Gangrenous Bladder and Ileum

An inguinal bladder hernia (IBH) is a common ailment in males above 50 years of age, with serious consequences of strangulation, if neglected. It is highly uncommon to have a strangulated inguinal hernia and bladder gangrene. This case reports a strangulated sliding inguinoscrotal hernia with a gangrenous bladder and ileum. We present a case of a 75-year-old man, presenting to the emergency room, with complaints of abdominal pain, distension, and absolute constipation. Examination revealed a large, firm, tender left-sided irreducible inguinal hernia. X-ray showed small bowel obstruction. Intraoperatively, a hernia sac was found with a gangrenous ileum as a slider along with a gangrenous fundus of the urinary bladder. Gangrenous segments were removed, and herniorrhaphy and bladder wall defect repair were performed. Even though a bladder can be involved in inguinal hernias, it is very rarely diagnosed preoperatively. In our case, there were no urinary symptoms, and the symptoms of strangulation outweighed bladder involvement. In any elderly patient with a giant hernia, a bladder entrapment should be ruled out with a strong index of suspicion. Failure to do so may result in complications after surgery. Hence, we conclude that it is better if all patients with long-standing giant hernias have a computed tomography (CT) prior to surgery.

Perforated sigmoid colon adenocarcinoma within an irreducible inguinal hernia: A case report

Inguinal hernia is a potentially occult common surgical condition. Its association with asymptomatic adenocarcinoma is uncommon. However, malignancy-associated perforation of the large bowel within an irreducible hernia is rare. We report a case of 78-year-old male presenting with a long-standing inguinal hernia with a 2-day history of irreducibility. Examination revealed a large left-sided irreducible inguinal hernia. Patient underwent urgent inguinal herniotomy, during which multiple perforations were noted in the sigmoid colon. Patient underwent Hartmann’s procedure following bowel resection. Histology revealed a mucinous adenocarcinoma with extensive metastasis involving the resection margins. Elderly patients with long-standing inguinal hernia presenting with acute symptoms should be evaluated further for this rare but sinister diagnosis.

Metastatic colon adenocarcinoma presenting as a giant inguinal hernia: A case report

INTRODUCTION AND IMPORTANCE

Giant inguinoscrotal hernias (GIH) are a rare form of inguinal hernia. There have been few reported cases of GIH containing colon adenocarcinoma.

CASE PRESENTATION

This case describes a 72-year-old male with a right GIH containing the right colon, terminal ileum, and associated mesentery with a large heterogenous, irregular mass with necrosis involving the cecum and ascending colon measuring 14 × 8 × 9 cm. The patient initially presented with pain and evidence of partial large bowel obstruction. Due to suspected extensive local invasion of tumor, the patient was scheduled for evaluation for possible neoadjuvant chemotherapy. Unfortunately, the patient re-presented with a large bowel obstruction and was subsequently taken for an exploratory laparotomy with trans-scrotal incision for en bloc resection of cecal adenocarcinoma and involved hernia contents.

CLINICAL DISCUSSION

Due to the rarity of this pathology, there is not a standard approach to management or optimal surgical technique described. In this case, a trans-scrotal incision paired with an exploratory laparotomy allowed for superior access to the adhered cancer containing bowel as well as skin excision, following standard oncologic principle of high ileocolic mesenteric excision.

CONCLUSION

The complexity of management of GIH containing colon cancer has been documented, however a standard oncologic approach has not been described. This case report presents exploratory laparotomy with trans-scrotal incision as an approach.

Sigmoid Colon Cancer Masquerading as a Right Incarcerated Inguinal Hernia: A Case Study and Literature Review

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.

Sigmoid Colon Carcinoma Presenting in Inguinoscrotal Hernia With FDG PET/CT

ABSTRACT

Primary carcinoma of the sigmoid colon in an inguinal hernia is a rare condition. We present a 79-year-old man diagnosed with sigmoid colon carcinoma referred to 18F-FDG PET/CT for staging. PET/CT showed the primary lesion in the inguinal hernia into scrotum.

Small Bowel Perforation as a Consequence of Strangulated Direct Inguinal Hernia

Inguinal hernia is probably one of the most common surgical conditions, with strangulation accounting for a good number of acute surgical admissions. It has always been known that direct hernias are less likely to strangulate due to wide hernial defects in comparison to indirect hernia. For that reason, some surgeons do not attempt repair of direct hernias in elderly patients. We present a relatively uncommon case of a 58-year-old gentleman who presented with clinical signs of an incarcerated inguinal hernia; which was found at exploration to be a strangulated direct hernia with small bowel perforation. We believe that direct inguinal hernia should always be included in the differential diagnosis of incarcerated or strangulated groin hernia.

Perforated sigmoid colon cancer presenting as an incarcerated inguinal hernia: A case report

BACKGROUND

Inguinal hernias are common among the population and usually contain part of the omentum or small bowel, however, other unusual contents have been reported. We report a case of a patient who presented for an incarcerated left inguinal hernia and was found to have an underlying perforated sigmoid cancer.

SUMMARY

An 87 years old man presented with typical signs of an incarcerated left inguinal area. During surgery, we dissected free a herniated hard inflammatory mass until it was found to be covering an underlying perforated sigmoid tumor. Inguinal hernia is a common condition affecting many individuals, and colorectal cancer is one of the rare contents reported inside these hernias. Due to the rarity of such a presentation, the surprise encounter during groin surgery may lead to suboptimal treatment. Perforated colorectal cancer, like in our case, may signify a more aggressive disease, and hence a correct diagnosis is crucial to improve outcomes. When underlying colon cancer is suspected during hernia surgeries, proper exploration and oncologic resection might be the optimal choice.

CONCLUSION

Surgeons should keep the possibility of underlying colorectal cancer in mind when operating on inguinal hernias and opt for oncologic resection of the identified tumor along with proper lymph node dissection.

A Rare Case of Sigmoid Colon Carcinoma in Incarcerated Inguinal Hernia

Incarcerated inguinal hernia is a common diagnosis in patients presenting a painful and nonreducible groin mass. Although the diagnosis is usually made by physical examination, the content of the hernia sac and the extent of the surgical operation may vary and can require multimodal imaging integration (e.g., ultrasonography, computed tomography); the usual finding is a segment of small bowel and, less commonly, large bowel. We present an extremely rare case of a sigmoid cancer incarcerated in a left inguinal hernia and infiltrating the spermatic cord. The patient underwent whole-body computed tomography (CT) with contrast agent injection for staging, followed by a left hemicolectomy paralleled by a unilateral orchiectomy.

Incarcerated sigmoid colon cancer in an inguinal hernia sac associated with an abdominal wall abscess: a case report

Background

An inguinal hernia is a common disease; however, a malignant tumor within the inguinal hernia sac is rare, and perforated colon cancer in the hernia sac is extremely rare.

Case presentation

A 73-year-old man presented to our hospital with high fever and painful bulging of the lower abdomen. Computed tomography showed air-containing fluid in the abdominal wall, as well as localized wall thickness of the sigmoid colon in the left groin. An emergency operation revealed a huge subcutaneous abscess and a hard mass of the sigmoid colon within an indirect inguinal hernia sac. Sigmoidectomy and hernia repair using the Marcy method were performed. Lymph node dissection was performed through a transrectal abdominal incision. Histopathological examination of the resected specimen revealed moderately differentiated adenocarcinoma invading the serosal layer with lymph node metastasis.

Conclusions

Incarcerated inguinal hernia with perforated colon cancer is rare; an emergent operation should accordingly be performed based on infection control, oncological principles, and secure hernia repair.

Perforated adenocarcinoma of the colon within a scrotal hernia imaged by CT: case report and literature review

Colorectal cancer is one of the most common cancers in the developed countries, and colon cancer is well documented. However, it is very rare for a primary colon cancer to exist in a scrotal hernia, and even rarer for the scrotal hernia to perforate. Here, we describe an unusual case where a 75-year-old patient with a colon tumor that perforated in a scrotal hernia. The teaching point is to highlight the computed tomography scan imaging characteristics of this rare finding in patients with both abdominal and scrotal pain.

Utility of 18F-Fluorodeoxyglucose Positron-emission Tomography/ Computed Tomography in the Detection of Primary Colonic Malignancy Presenting as an Inguinoscrotal Hernia

Carcinoma of the sigmoid colon presenting in an inguinoscrotal hernia is uncommon. Many of the cases seen in literature were diagnosed only intraoperatively, as most of them had misleading presentations. We report a case of carcinoma of the sigmoid colon in an incarcerated inguinoscrotal hernia with imaging findings of 18F-FDG PET/CT along with a brief review of the literature.

A rare case of ascending colon adenocarcinoma incarcerated in an inguinoscrotal hernia: case report and literature review

Background

Inguinal hernias and colorectal cancers are common conditions, but the presentation of a loop of bowel containing cancer within a hernia is rare. Principles of surgery include oncological resection of the involved colonic segment as well as lymphatic drainage. Based on case reports of the last several decades, there have been no reports of a case where the reduction of an inguinoscrotal hernia and oncological colectomy were performed completely laparoscopically. We present the first instance of a completely laparoscopically assisted resection and hernia repair on a patient with T4 ascending colon cancer. A literature search on recent case reports over the last 30 years has also been presented with a focus on trends in treatment.

Case presentation

An 83-year-old man presented for further investigation of his iron deficiency anaemia and was diagnosed with adenocarcinoma of the ascending colon. This was demonstrated radiologically to be found within a large right inguinoscrotal hernia. He underwent a laparoscopically assisted right hemicolectomy and laparoscopic closure of the internal ring and recovered well.

Conclusions

Colorectal cancers within inguinal hernias are rare and can often present with complications such as perforation. As such, treatment has mostly involved an open operation. The last few years have shown feasibility of a laparoscopic approach and can be attempted safely when indicated.

Small bowel lymphoma presenting as inguinal hernia: case report and literature review

Background

Inguinal hernia is one of the most common benign pathologies that primarily affects men. Primary gastrointestinal non-Hodgkin’s lymphoma (PGI NHL) is the most common type of extranodal lymphoma. This study reports a rare case in which these two conditions co-exist.

Case presentation

An 85-year-old male complained of bowel movement pattern change, abdominal distension and loss of weight, without vomiting but with nausea. A computed tomographic scan of the abdomen showed a small bowel obstruction caused by a migration of a small bowel loop in the right inguinal canal, with a clinically non-reducible inguinal hernia. The patient underwent surgery. The histopathological report showed small bowel large B cell non-Hodgkin’s lymphoma.

Conclusion

When the diagnosis of the contents of an inguinal hernia is not well-established, surgery should be performed as soon as possible to ensure the cure of the disease and the correct diagnosis of the contents.

Inguinoscrotal herniation of a caecal adenocarcinoma

An 84-year-old man with multiple comorbidities presented from a residential care home with a 1-month history of asthenia and moderate abdominal pain. On examination, he was found to have an irreducible right-sided inguinoscrotal hernia. Subsequent blood tests revealed a significant anaemia (haemoglobin 48 g/L), for which he was transfused. A CT scan of the abdomen and pelvis revealed a large caecal tumour, herniating through the right inguinal canal into the scrotum. The patient underwent an elective open right hemicolectomy with inguinal hernia defect repair, from which he recovered well. He was discharged from the ward 12 days postoperatively and is awaiting outpatient follow-up.

Intrasaccular caecal adenocarcinoma presenting as enlarging right inguinoscrotal hernia

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.

Bilateral saccular inguinal hernias in an elderly woman presenting with advanced ovarian cancer

We present a case of an elderly woman presenting with bilateral groin hernias, one reducible and the other irreducible. CT of the abdomen and pelvis demonstrated an irreducible left inguinal hernia containing an incarcerated loop of transverse colon together with saccular metastatic tumour spread. Disseminated omental disease and ascitic fluid were noted throughout the peritoneal cavity secondary to ovarian carcinoma. As a consequence of extensive malignant disease and advanced age, the patient was treated conservatively and subsequently died a number of weeks later. To the best of our knowledge, this is only the second case of bilateral inguinal hernias presenting in a woman with a background of disseminated ovarian malignancy. This case highlights the importance of pre-reduction imaging in atypical complex cases.

Sigmoid carcinoma in an inguinal hernia: a blessing in disguise?

Colorectal cancer is a rising problem, as the incidence increases with age. In most cases the goal of treatment is oncological resection followed by adjuvant chemotherapy in order to optimize the survival. In this case report we present a 93-year-old patient with a sigmoid carcinoma inside an irreducible inguinal hernia, which was diagnosed prior to surgery. We chose to perform a sigmoid resection through an oblique inguinal incision as a safer alternative to laparotomy.

Locally advanced carcinoma of the cecum presenting as a right inguinal hernia: a case report and review of the literature

Introduction

An inguinal hernia is a common surgical disease in elderly patients, but an association with intra-abdominal malignancies is rare.

Case presentation

We report a case of a 78-year-old Caucasian woman presenting with a right inguinal mass suspected to be an irreducible hernia. A computed tomography scan showed the presence of the cecum in her inguinal canal, with an irregular thickening of the cecal wall suggesting a neoplasm within the inguinal hernia. A colonoscopy was not completed owing to the huge involvement of the cecum into the hernia sac. A laparotomy was performed, at which time the cecum was herniated through her right inguinal canal and the cecal tumor had infiltrated her abdominal wall and femoral artery. A right inguinal incision was necessary for good vascular control and to carry out an en bloc resection of the tumor with the inguinal wall. A right colectomy was performed and the inguinal wall repaired. The postoperative course was uneventful and our patient received adjuvant radiochemotherapy.

Conclusion

We describe a rare case of a locally advanced cecal tumor presenting as a right inguinal hernia. Both diagnosis and surgical treatment in elderly patients represent a challenge for the surgeon in cases of aggressive tumors as reported in this paper.

Elective laparoscopic surgery for sigmoid colon carcinoma incarcerated within an inguinal hernia: report of a case

Primary colon carcinoma within an inguinal hernia sac is very rare and most reported cases were found at emergency open surgery for an incarcerated hernia. We report a case of incarcerated sigmoid colon carcinoma diagnosed preoperatively and treated with elective laparoscopic surgery. A 67-year-old man with a 2-year history of swelling of the scrotum and a breast lump was referred to us for surgical treatment of an irreducible left inguinal hernia and a right breast tumor. Blood examination results showed severe anemia. Computed tomography scan and endoscopic biopsy confirmed sigmoid colon carcinoma incarcerated in the left inguinal hernia. Thus, we performed definitive laparoscopic sigmoidectomy and conventional hernia repair for preoperatively diagnosed sigmoid colon carcinoma within an inguinal hernia.

Laparoscopic treatment of a carcinoma of the cecum incarcerated in a right groin hernia: report of a case

A carcinoma in a groin hernia is uncommon. We herein report a case of an intrasaccular carcinoma of the cecum in a right inguinoscrotal hernia with a simultaneous left inguinal hernia treated by a laparoscopic approach. A 70-year-old man presented with a painful, not completely reducible bilateral hernia. Blood examinations showed severe anemia. A computed tomography scan of the abdomen confirmed the presence of the cecum in the hernia sac, showing a round wall thickening of the herniated portion of the colon. A standard laparoscopic right colectomy with radical oncological purpose was performed. An incarcerated inguinal hernia is a relatively common surgical problem. In the case of anemia or other signs suggestive of malignancy, a specific preoperative work-up should be assessed. This case demonstrates that it is possible to perform an oncologically correct laparoscopic resection when the presence of malignancy is confirmed while performing an open traditional hernioplasty to avoid any possible contamination of the mesh.

An unusual case of a strangulated right inguinal hernia containing the sigmoid colon

The strangulated inguinal hernia is one of the most common emergencies in surgery. Although the diagnosis is usually made by physical examination, the content of the hernia sac and the extent of the following operation may vary. We present an extremely rare case of a strangulated right inguinal hernia containing the sigmoid colon and review the relevant literature.

Perforated sigmoid colon cancer within an irreducible inguinal hernia: a case report

A perforated sigmoid colon cancer within an inguinal hernia is extremely rare. This unexpected finding is usually discovered during surgery and causes an unavoidable septic evolution. Here, we describe the case of an 84-year-old man who presented with fever, abdominal distension, and a painful, enlarged, left scrotum. A CT showed a left, incarcerated, inguinal hernia containing a perforated sigmoid adenocarcinoma (which was confirmed by histopathology). The possibility of an irreducible inguinal hernia in association with perforated sigmoid colon cancer should be considered in the array of diagnoses. A pre-operative CT scan would be helpful in facilitating an accurate diagnosis.