Giant inguinal hernia containing right colon repaired using the prolene hernia system

Treatment of a half century year old giant inguinoscrotal hernia. A case report

•

Giant inguinoscrotal hernias are a rare entity in modern clinical practice mainly because of the patient’s neglect.

•

Our patient had a type II giant inguinoscrotal hernia extending below the midline between mid-inner thigh and suprapatellar bone lines.

•

We avoided preoperative or intraoperative procedures for the lengthening of the abdominal wall.

•

Despite the longevity and size of the hernia, we avoided a debulking procedure, instead we performed a lower midline incision and connected it with an extended right inguinal incision.

•

Patient’s recovery was uneventful with no complications or signs of recurrence at 6 month follow up.

Introduction

Inguinal hernias, although a common medical entity, can on rare occasions present as giant inguinoscrotal hernias, mostly because of the patient’s rejection of timely surgical management.

Presentation of case

A 77 year old patient, with a giant inguinoscrotal hernia history for more than 50 years, was advised to undergo surgical treatment due to recurrent urinary tract infections and vague abdominal pain. Physical examination showed a right sided giant inguinoscrotal hernia extending below the midpoint of the inner thigh. Preoperative CT examination confirmed a giant inguinoscrotal hernia containing the whole of the small bowel along with its mesentery.

Discussion

Giant inguinoscrotal hernias are classified into three types based on size, with each one posing a challenge to treat. There are a number of surgical options and recommendations available, depending on the type of hernia. They require close postoperative observation, because the sudden increase in the intra-abdominal pressure can account for a number of complications. Our case was classified as a type II hernia, having longevity of more than 50 years. Despite this, it was treated with forced reduction and no debulking through an extended inguinal and lower midline incision, forming a ‘V shaped’ incision. Patient recovery was uneventful and he was discharged on the 10th postoperative day.

Conclusion

Preoperative management and the correct surgical plan depending on the case are key elements in the successful treatment of this rare surgical entity.

Giant inguinoscrotal hernia containing intestinal segments and urinary bladder successfully repaired by simple hernioplasty technique: a case report

Introduction

Giant inguinoscrotal hernias are extremely rare nowadays, but they may still be encountered after years or even decades of neglect. Such hernias containing both bowel loops and urinary bladder have not been reported in the medical literature to date, to the best of our knowledge.

Case presentation

We report a case of a 65-year-old Moroccan man who presented with giant right-sided and long-standing inguinoscrotal hernia with compromised quality of life due to walking difficulties and sexual discomfort. Computed tomography revealed a voluminous hernia sac containing small and large bowel loops, greater omentum, and urinary bladder. Surgical repair was done through the classical inguinal incision using the Lichtenstein tension-free hernioplasty technique. No debulking or abdominal enlargement procedure had to be performed, apart from a partial omentectomy.

Conclusions

Giant inguinoscrotal hernia containing intestinal segments and urinary bladder is a challenging surgical disease. A Lichtenstein tension-free technique seems to be the best surgical procedure for both the patient and the operating surgeon. It should be used whenever possible in such cases.