A case of duodenal rupture secondary to massive inguino-scrotal hernia

Acute Scrotal Abdomen: An Epitome of Negligence in Rural India

An inguinoscrotal hernia is considered to be giant when it passes beyond the midpoint of the thigh in a standing position. It is a rare condition that can lead to complications such as obstruction and perforation. Here, we present the case of a 35-year-old male who was diagnosed with a giant inguinoscrotal hernia with transverse colon perforation peritonitis. The patient presented with acute abdomen and septic shock. On presentation, resuscitation was started and an emergency laparotomy was performed. Resection of the gangrenous bowel segment and end jejunostomy was done as damage control surgery. However, despite intensive care and efforts, the patient succumbed due to multiorgan dysfunction syndrome (MODS). This is a rare case of a giant inguinoscrotal hernia with transverse colon perforation peritonitis, leading to MODS and mortality.

A case report of a gastric perforation in a giant inguinoscrotal hernia: A two-step approach

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Gastric perforation in a giant inguinal hernia is a rare and morbid complication.

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Repair of a giant inguinal hernia complicated by gastric perforation should be delayed when possible.

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Gastric rupture in a giant inguinal hernia is the result of the downward pulling exerted by the hernia content.

Introduction

An inguinoscrotal hernia is defined as giant if descending below the midpoint of the inner thigh of a patient in upright position. It is an uncommon condition and rarely encountered in clinical practice that can lead to severe complications such as gastric perforation.

Presentation of case

We present a case of a 50-year old male suffering from a gastric perforation in a giant inguinoscrotal hernia that was managed in a two-step approach.

Discussion

In our patient, we opted for a two-step approach. The initial phase consisted in the release of the stomach, repair of the perforation, the control of the infection and the stabilization of the patient. The repair of the hernia was performed uneventfully three months later in the second phase.

Conclusion

In a giant inguinal hernia with gastric perforation, delaying the hernia repair when possible can decrease the complexity of the procedure and most likely its morbidity and mortality.

Duodenal rupture due to giant inguinal hernia: A case report

INTRODUCTION

Giant inguinal hernia is unusual, and duodenal rupture accompanying it is particularly very rare and significantly hard to manage surgically.

PRESENTATION OF CASE

An 81-year-old man was admitted to our institution with upper abdominal pain. He had tenderness of the upper mid abdomen and a bilateral large inguinal hernia but he did not have pain in the inguinal-scrotal area. Computed tomography (CT) showed slight dilatation of the small bowel and stomach. There were no remarkable signs of incarceration of the inguinal hernia. Therefore, he was admitted to the internal ward. On the second day in hospital, he suddenly went into shock. CT revealed that there was free air and ascites in the inguinal hernia and therefore an emergency operation was performed. The tranverse colon, ascending colon, and ileum were incarcerated, and perfolation of the cecum was found. We also detected duodenal rupture at the inferior duodenal angle. We resected the terminal ileal (almost 90cm) and ileocecal area, followed by side-to-side anastomosis of duodenum and jejunum. We only repaired the peritoneum at the internal hernia ring. After the operation, despite intensive-care therapy, this patient passed away on the 18th postoperative day.

DISCUSSION

The mesocolon and third portion of the duodenum were strongly pulled down into giant inguinal hernia, probably causing the rupture of the inferior duodenal angle.

CONCLUSION

Giant inguinal hernia possibly provokes duodenal rupture and therefore should definitively be repaired if feasible.