Intestinal perforation from blunt trauma to an inguinal hernia

Trauma to an inguinal hernia resulting in bowel rupture: A case report and literature review

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A male patient developed intestinal perforation and spreading peritonitis after his longlasting inguinal hernia hurt by a minor trauma.

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The patient underwent an immediate exploratory celiotomy and delayed hernia repair.

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Postoperative histology showed chronical inflammation of the perforated bowel .

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Trauma directly to a known inguinal hernia is a rare, but a dangerous event,which may be due to the abnormal intestine in the hernia sac tending to be broken .

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It is the physician’s responsibility to persude the patient to have his hernia repaired as early as possible.

Introduction

We report on a rare case of a man with bowel rupture due to direct trauma to his diagnosed inguinal hernia, with reviewing the relevant literature, we have found some characteristics of our case different from the similar cases reported by other authors.

Presentation of the case

A 54-year-old man, with a dignosed right inguinal hernia without treatment for over six months, presented to our hospital with generalized peritonitis and possible sepsis, caused by minimal hit directly to his hernia. The patient underwent an immediate exploratory celiotomy with segmental intestine resection and anastomosis, without hernia repair at the same time because of the concomitant peritonitis. The patient recovered uneventfully and postoperative histology showed chronical inflammation of the perforated bowel. Later, he patient had his hernia repaired by elective operation.

Discussion

Different from other cases of the same kind, our patient only suffered a trivial blunt trauma, so we believe that the longlasting inflammation of the intestine is one of the major reasons for such a bowel perforation, which differs from the opinion that external force is the crucial factor. Besides, after the first non-herniorrhaphy procedure, our patient kept no recurrent hernia for about 10 months until it’s recurrence and had the herniorrhaphy.

Conclusion

Trauma directly to a known inguinal hernia is an uncommon, but a dangerous event, and the abnormal alterations of intestine in the hernial sac may be one of the major reasons for such event, so it is mandatory for the physician to explain the complication of the hernia to the patient, for the hernia being repaired as early as possible.

Rare Case of Large Bowel Injury due to Direct Blunt Trauma to a Preexisting Femoral Hernia

We report a case of an 85-year-old man with a known asymptomatic left femoral hernia who was admitted to the emergency ward a few hours after falling from a bicycle and suffering from blunt trauma of the handlebar to the left inguinal region. The clinical findings and a computed tomography (CT) scan detecting free air in the femoral hernia sac suggested bowel perforation. Emergency laparotomy 6 hours after the incident confirmed a tear of the sigmoid colon accompanied by free blood and faeces in the left inguinal region of the abdomen. A segmental sigmoid resection and a primary end-to-end colorectal anastomosis were performed. The postoperative course was complicated by delayed oral feeding, a local infection, and a partial left testicle necrosis that led to secondary resection. The patient was discharged after 32 days of in-hospital care. Three months post trauma, we recorded a restitutio ad integrum. The case exemplifies that blunt trauma to preexisting femoral hernias may cause potentially lethal bowel perforation and that the time interval between time of injury and surgical treatment may be a prognostic factor. CT scans seem most suitable for ruling out bowel perforation. The scarce literature for blunt trauma to hernias is reviewed.

Diagnosis of an inguinal hernia after a blunt inguinal trauma with an intestinal perforation

Introduction. Inguinal hernias are very common in men. A clinical exam can do the diagnosis easily. But bowel perforation inside an inguinal hernia caused by a directly blunt trauma is rare and can have important consequences. Up to now, there have been a few case reports that described blunt injury to the inguinal area causing traumatic perforation of the bowel in the inguinal hernia. Case Report. We present a case of a 45-year-old Eastern European man with a small perforation of ileal bowels and a peritonitis after direct blunt trauma to the inguinal hernia region, with no inguinal hernia known by the patient, and show how the diagnosis can be difficult. Conclusion. This case shows that external forces, that may seem too trivial to cause intraperitoneal injury, can cause significant injury when applied to a patient with a hernia and shows how a careful examination, with the help of an abdominal CT scan, is important even if the patient do not seem to have an inguinal hernia.

Small bowel perforation due to blunt trauma to an inguinal hernia: a case report and literature review

We report the case of a 41-year-old man with a known right inguinal hernia presenting with groin pain following a fall while dog walking. Operative findings showed a small bowel perforation affecting the loop of bowel in the hernial sac. Bowel perforations caused by blunt abdominal injury in patients with an inguinal hernia is a rare and not well recognised problem, and are confined to a handful of case reports in the surgical literature.

Colonic perforation following blunt trauma to an inguinal hernia

External forces that may appear trivial in the setting of blunt abdominal trauma can cause significant hollow viscus injury when applied directly to an inguinal hernia. We report a very rare case of colonic perforation following a direct blow to an inguinal hernia sustained during a rugby union match and review the relevant literature.

Intestinal perforation secondary to blunt inguinal trauma in a soccer player: a case report

BACKGROUND

Intestinal perforation caused by blunt trauma to an inguinal hernia is a very uncommon event.

CASE REPORT

We present the case of a 55-year old man who suffered trauma to the inguinal area while playing soccer and later developed intense abdominal pain with no categorical signs of peritoneal irritation. Computed tomography scan at arrival showed a right inguinal hernia, with partial protrusion of the ileum, inflammatory changes of the mesenteric fat tissue inside the hernial sac, and free intraperitoneal fluid. Several hours later he developed hypotension and fever. An emergency laparotomy was performed, revealing ileum perforation with peritonitis. Intestinal perforation was repaired without intestinal resection. After surgery, the patient developed severe septic shock with multiple organ failure. He recovered without sequelae and was discharged 3 weeks later.

CONCLUSION

This case emphasizes the potential clinical complications associated with this condition.

[Intestinal perforation following blunt abdominal trauma in patients with pre-existing inguinal hernia]

BACKGROUND

Intestinal perforation following blunt trauma to the abdomen is a rare but life-threatening complication in patients with pre-existing inguinal hernia.

MATERIAL AND METHODS

We examined retrospective case series of patients with intestinal perforation following blunt abdominal trauma.

RESULTS

Within 2 years, three patients with pre-existing inguinal hernia were referred to our clinic following simple falls while cross-country skiing. Upon signs of abdominal tenderness and radiographic evidence of free air, explorative laparotomy with revision of the affected bowel segments was performed. The postoperative course was uneventful in two patients. One developed adhesive ileus and incisional hernia within 1 year.

CONCLUSIONS

Intestinal perforation must be suspected in patients with inguinal hernia and signs of diffuse abdominal tenderness following blunt trauma. Urgent explorative laparotomy with revision of the affected bowel segments is mandatory in patients with free abdominal air. Secondary hernia repair may represent the safest and most reliable approach and should be delayed until full recovery from the initial surgery.

[Traumatic perforation of the sigmoid colon: role of computed tomography]

The authors report a case of a delayed traumatic perforation of the sigmoid colon, presenting three days after a motor vehicle accident. A review of the literature is presented.