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Narayanan S, Kumar A, Reljic T, Blonski W. Is inguinal hernia associated with an increased risk of colon cancer? A systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:1209-1214. [PMID: 35487979 DOI: 10.1007/s00384-022-04168-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The presence of an inguinal hernia has been associated with an increased risk of identifying colon cancer, and therefore colonoscopy is recommended prior to inguinal hernia repair. However, the evidence on the association between the presence of an inguinal hernia and colon cancer is conflicting and uncertain. We performed a systematic review and meta-analysis to synthesize all available evidence on this topic. METHODS A comprehensive search of PubMed and EMBASE was performed. Any comparative study (case-control or cohort study) comparing the rate of colon cancer detection in patients with and without inguinal hernias who underwent screening colonoscopy or flexible sigmoidoscopy was eligible for inclusion. Data were extracted and pooled under a random effects model. RESULTS The initial search identified 692 references, of which 4 comparative studies (1462 patients) met the inclusion criteria. The overall risk of bias in the included studies was low. Pooled results showed a statistically non-significant difference in the incidence of detection of colon cancer, with patients with inguinal hernia having a 1.26 times increased likelihood of colon cancer diagnosis compared with patients without inguinal hernia (odds ratio (OR) 1.26; 95% confidence interval (CI) 0.63-2.51; P = 0.51). Although patients with inguinal hernia were also 1.23 times more likely to be diagnosed with colon polyps compared to patients without inguinal hernia, this difference was statistically non-significant (OR 1.23; 95% CI 0.94-1.60; P = 0.12). CONCLUSION The findings from this first systematic review and meta-analysis show that there is no difference in the incidence of either colon cancer or colon polyps in patients presenting with inguinal hernias compared to those without. Nevertheless, larger prospective studies are needed to further investigate the relationship between the risk of colon cancer or polyps and the presence of inguinal hernia.
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Affiliation(s)
- Shreya Narayanan
- Division of Gastroenterology, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Ambuj Kumar
- Research Methodology and Biostatistics Core, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Tea Reljic
- Research Methodology and Biostatistics Core, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Wojciech Blonski
- Division of Gastroenterology, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. .,Division of Gastroenterology, James A Haley Veterans' Hospital, 13000 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
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Lai WC, Sellapan M, Raja Ram NK, Tan Chor Lip H. Perforated caecal carcinoma within a strangulated inguinal hernia. ANZ J Surg 2021; 92:1512-1513. [PMID: 34664767 DOI: 10.1111/ans.17304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Wick Champ Lai
- Department of General Surgery, Hospital Sultan Ismail, Johor Bahru, Malaysia
| | - Mogaraj Sellapan
- Department of General Surgery, Hospital Sultan Ismail, Johor Bahru, Malaysia
| | | | - Henry Tan Chor Lip
- Department of General Surgery, Hospital Sultan Ismail, Johor Bahru, Malaysia
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Quinn E, Miller N, Capanegro J, Smith T. Small cell neuroendocrine carcinoma presenting as inguinal hernia: A case report. Ann Med Surg (Lond) 2021; 65:102310. [PMID: 33981426 PMCID: PMC8082203 DOI: 10.1016/j.amsu.2021.102310] [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: 02/26/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction One of the most common surgical procedures performed annually is inguinal hernia repair. Inguinal hernias are traditionally known to be caused by a weakening in the abdominal wall and precipitated by increased intraabdominal pressure. Recently, intra-abdominal cancer producing the increased intraabdominal pressure, along with metastasis directly into the inguinal canal, have been identified in more studies as causes of inguinal hernias. Presentation of case This case focuses on a unique presentation of small-cell neuroendocrine carcinoma presenting as an inguinal hernia. Discussion This patient's rapid demise and advanced metastatic disease upon presentation is alarming, but his advanced disease process presenting as a routine inguinal hernia is noteworthy. Upon literature analysis, the number of advanced disease processes – most notably cancer – presenting as hernias is significant. Conclusion This case emphasis the importance of perioperative screening, and presents the question, should hernias indicate further workup in the appropriate, at-risk patient populations. Small cell neuroendocrine carcinoma is a highly malignant, poorly defined cancer with a wide variety of metastasis sites. The clinical presentation of intra-abdominal cancer within inguinal hernia has mounting supporting evidence. Late metastatic small cell lung carcinoma developed in inguinal hernia from an increase in intra-abdominal pressure. Further screening for malignancies in those who present for an evaluation of a hernia may be merited.
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Affiliation(s)
- Erina Quinn
- Lake Erie College of Osteopathic Medicine, Bradenton, United States
| | - Natalie Miller
- Lake Erie College of Osteopathic Medicine, Bradenton, United States
| | - James Capanegro
- Lake Erie College of Osteopathic Medicine, Bradenton, United States
| | - Travis Smith
- Lake Erie College of Osteopathic Medicine, Bradenton, United States
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Grossi U, Santoro GA, Tagliente G, Zanus G. Sigmoid colon adenocarcinoma incarcerated in an inguinoscrotal hernia: diagnostic and management challenges. ANZ J Surg 2020; 91:E391-E392. [PMID: 33104277 DOI: 10.1111/ans.16407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ugo Grossi
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Padua, Italy.,Centre for Trauma and Surgery, Queen Mary University of London, London, UK
| | | | - Giovanni Tagliente
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Padua, Italy
| | - Giacomo Zanus
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Padua, Italy
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Mizuno H, Nagai H, Maeda S, Miyake H, Yoshioka Y, Yuasa N. Incarcerated sigmoid colon cancer in an inguinal hernia sac associated with an abdominal wall abscess: a case report. Surg Case Rep 2019; 5:189. [PMID: 31807907 PMCID: PMC6895366 DOI: 10.1186/s40792-019-0742-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/29/2019] [Indexed: 01/02/2023] Open
Abstract
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.
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Affiliation(s)
- Hironori Mizuno
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, 453-8511, Japan. .,Department of Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, 453-8511, Japan.
| | - Hidemasa Nagai
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, 453-8511, Japan
| | - Shingo Maeda
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, 453-8511, Japan
| | - Hideo Miyake
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, 453-8511, Japan
| | - Yuichiro Yoshioka
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, 453-8511, Japan
| | - Norihiro Yuasa
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, Nagoya, 453-8511, Japan
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Mandava A, Koppula V, Abubakar ZA. Utility of 18F-Fluorodeoxyglucose Positron-emission Tomography/ Computed Tomography in the Detection of Primary Colonic Malignancy Presenting as an Inguinoscrotal Hernia. Indian J Nucl Med 2019; 34:140-142. [PMID: 31040527 PMCID: PMC6481204 DOI: 10.4103/ijnm.ijnm_149_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Anitha Mandava
- Department of Radiodiagnosis, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Veeraiah Koppula
- Department of Radiodiagnosis, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Zakir Ali Abubakar
- Department of Nuclear Medicine, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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Chern TY, Tay YK, Perera DS. A rare case of ascending colon adenocarcinoma incarcerated in an inguinoscrotal hernia: case report and literature review. Surg Case Rep 2018; 4:48. [PMID: 29785528 PMCID: PMC5962524 DOI: 10.1186/s40792-018-0457-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/14/2018] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Tien Yew Chern
- Department of Colorectal Surgery, St George Hospital, 5/61 Port Hacking Road, Sylvania, NSW, 2224, Australia.
| | - Yeng Kwang Tay
- Department of Colorectal Surgery, St George Hospital, 5/61 Port Hacking Road, Sylvania, NSW, 2224, Australia
| | - Dayashan Shevantha Perera
- Department of Colorectal Surgery, St George Hospital, 5/61 Port Hacking Road, Sylvania, NSW, 2224, 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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Slater R, Amatya U, Shorthouse AJ. Colonic carcinoma presenting as strangulated inguinal hernia: report of two cases and review of the literature. Tech Coloproctol 2008; 12:255-8. [PMID: 18798013 DOI: 10.1007/s10151-008-0388-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 03/15/2007] [Indexed: 10/21/2022]
Abstract
Inguinal hernia and colonic carcinoma are common surgical conditions, yet carcinoma of the colon occurring within an inguinal hernia sac is rare. Of 25 reported cases, only one was a perforated sigmoid colon carcinoma in an inguinal hernia. We report two cases of sigmoid colon carcinoma, one of which had locally perforated. Each presented within a strangulated inguinal hernia. Oncologically correct surgery in these patients presents a technical challenge.
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Affiliation(s)
- R Slater
- Rotherham General Hospital, Moorgate Road, Rotherham, UK.
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