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

A Complicated Case of Strangulated Inguinal Hernia of the Sigmoid Colon With Secondary Ischemic-Compromise of Scrotal Tissue: A Multi-Disciplinary Surgical Approach

Inguinal hernia is amongst the most common acute abdominal disease that presents in the Emergency Department (ED). Pathologically, it involves the displacement and herniation of abdominal, pelvic, or groin tissue through weaknesses in the abdominal wall. Many inguinal hernias are simple and asymptomatic, managed conservatively without the need for surgical intervention. However, under rare circumstances, hernias are susceptible to significant complications requiring emergent surgery. This report follows the case of a 61-year-old Hispanic-American male presenting to the ED with signs of a complex strangulated inguinal hernia and consequent infarction of the testis with Fournier's Gangrene. Clinical evaluation elucidated a one-week worsening abdominal pain, non-reducible painful inguinal hernia, nausea, vomiting, constipation, groin discoloration, dysuria, and a history of failed primary hernia repair during childhood. The patient underwent emergent surgery to excise ischemic-necrotic portions of the sigmoid colon, creation of end-colostomy, non-mesh repair of inguinal hernia, and right-sided complete orchiectomy with the removal of adjacent scrotal-Dartos tissues and spermatic cord due to Fournier's Gangrene. This report provides both a report for a potentially preventable consequence in one of the most common surgical presentations and a review of the multi-disciplinary expertise that is required in the surgical management of complex inguinal hernias.

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.

Inguinal Hernia in Nonhuman Primates: From Asymptomatic to Life-Threatening Events

In this study, a review of available data and literature on the epidemiology and anamnesis of inguinal hernias in nonhuman primates, as well as on their clinical evaluation and surgical management, was conducted. Inguinal hernias are assumed to be relatively common in male nonhuman primates. Clinical signs are usually limited to a visible or palpable mass in the groin region without pain or systemic illness. Most hernias contain omentum. Careful monitoring is an acceptable treatment option for those animals. Size, the danger of incarceration, and the presence of strangulation are important factors when considering surgical repair. A strangulated inguinal hernia is an emergency, requiring prompt surgery to avoid tissue necrosis and death. Imaging techniques, as well as computed tomography (CT), ultrasonography, and magnetic resonance imaging (MRI), provide information about the anatomical characteristics of the suspected region, allowing for a diagnosis and treatment. An inguinal hernia repair can be performed with either open surgery or laparoscopic surgery. The hernia repair can be achieved by mesh or suture. Decisions regarding which repair technique to use depend on the surgeon′s skill level and preference. Complication and recurrence rates are generally low. The most common postsurgical complication is a recurrence of the hernia. Contraceptive measures are not indicated in breeders, as there is no known hereditary component, and the presence of hernia does not appear to affect fertility, nor does it predispose to occurrence, recurrence, or incarceration.

Incarcerated right inguinal hernia containing sigmoid colon: An unusual case report

Introduction

Incarcerated inguinal hernia is an irreducible but the blood supply to the contained part is intact, but developing towards strangulation. Diagnosis usually made by physical examination. The content of hernia sac may vary. The usual finding is a segment of small intestine and less commonly large intestine. Except in sliding hernia, the sigmoid colon is not common in inguinal hernia, especially on the right side.

Case report

We report a rare case of an incarcerated right side inguinal hernia containing the sigmoid colon of a 65-year old male, diagnosed with physical examination and abdominal ultrasonography. This patient treated by reducing the content of hernia sac and herniorraphy in general surgery ward of Aliabad Teaching Hospital.

Discussion

Inguinal hernia is the commonest of all groin hernia. Incarcerated inguinal hernia can lead to intestinal obstruction, strangulation and infarction. The content of inguinal hernia varies widely. In our case, the content of hernia sac was the incarcerated loop of sigmoid colon. The sigmoid colon is commonly found to herniate at the left inguinal region, but as a content of a right side inguinal hernia is rare.

Conclusion

The sigmoid colon as a content of a right side inguinal hernia is rare. Mesh repair has always been a subject of debate due to increased risk of mesh infection rates. Many patients present complications due to delayed elective repair of inguinal hernia.

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The sigmoid colon as a content of a right side inguinal hernia is rare.

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Mesh repair in situations of incarcerated hernia has been a subject of debate due to increased risk of mesh infection rates.

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Many patients present complications due to delayed elective repair of inguinal hernia.

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.

Pericecal herniation of sigmoid colon diagnosed by computed tomography: Two case reports

INTRODUCTION

Computed tomography (CT) plays an important role in diagnosing specific types of internal hernias and their complications. In particular, pericecal hernia of the sigmoid colon has never been reported in the English literature.

CASE PRESENTATION

The first patient was a 46-year-old female presented to our institution due to acute abdominal pain. The second patient was a 55-year-old male presented to our institution with continuous diarrhea. The patient underwent colonoscopy for further evaluation. However, even with sufficient air insufflation and repetitive maneuvers, the colonoscope could not proceed beyond the narrowed level of the sigmoid colon. In both cases, contrast-enhanced abdominal CT was done and a herniated loop of sigmoid colon was noted in the posterolateral aspect of the cecum and ascending colon. Thus, a diagnosis of pericecal herniation of the sigmoid colon was established.

CONCLUSION

This case study indicates that radiologic examination can be helpful in detecting pericecal herniation of the sigmoid colon.

Strangulation and necrosis of an epiploic appendage of the sigmoid colon in a right inguinal hernia

An epiploic appendage of the sigmoid colon is considered to be an unusual type of inguinal hernia content. The strangulation of a sigmoid colon appendage into a right inguinal hernia is exclusively rare. We present a case of an 81-year-old female patient with severe cardiovascular comorbidities who was urgently admitted after an episode of strangulation and subsequent spontaneous reduction of a right inguinal hernia. The condition of the patient was stable, and an urgent operation was not indicated for three days after admission. However, we had to operate because the hernia strangulation recurred. In the hernia sac, a free fatty body (a separated and saponified epiploic appendage of the colon) and a strangulated epiploic appendage of dolichosigmoid, with signs of necrosis, were found. Removal of the free fatty body and necrotic epiploic appendage and subsequent anterior-wall inguinal hernioplasty were successfully performed. In the world literature, this case may be the first report of a sigmoid epiploic appendage strangulation in a right inguinal hernia that is well documented by photography.