An Incarcerated Colon Inguinal Hernia That Perforated into the Scrotum and Exhibited an Air-Fluid Level

Closed-loop bowel obstruction caused by a right inguinal hernia containing the transverse colon: an unusual case report

Inguinal hernias are common, with a lifetime risk of 25% in men. Approximately 10% become incarcerated, risking complications like strangulation and bowel obstruction. Herniation of the transverse colon (TC) is rare, especially when causing a closed-loop obstruction. A 67-year-old male with poorly controlled type II diabetes and hypertension presented with a symptomatic right inguinoscrotal hernia, showing nausea, vomiting, and partial bowel obstruction. A computed tomography (CT) scan revealed a herniated TC causing a closed-loop obstruction. Emergency open hernia repair with a modified Shouldice technique and mesh was performed. Viable TC and omentum were reduced. The patient recovered without complications and was discharged on the fourth postoperative day. This case involved a rare TC herniation causing a closed-loop obstruction, confirmed by CT imaging. The open approach was selected due to the risk of ischemia and anticipated adhesions. A modified Shouldice repair with mesh reinforced the inguinal canal, reducing recurrence risk. The patient's postoperative course was uneventful. This case highlights the rarity of TC herniation causing closed-loop obstruction. CT scans were crucial for diagnosis, enabling prompt surgical intervention, which is key to preventing serious complications.

Fecal Scrotal Abscess Secondary to Spontaneous Retroperitoneal Perforation of Ascending Colon

Introduction

Fecal abscess or enterocutaneous fistulas of the scrotum are rare and are invariably the result of incarcerated bowel loop in inguinal hernia. Spontaneous perforation of the colon (SPC) having no definite cause is also rare. Much rarer is posterior colonic perforations causing an extensively large retroperitoneal abscess. Similarly, spread of retroperitoneal abscess to the thigh or scrotum has rarely been reported. We report a case of spontaneous posterior perforation of ascending colon resulting in large retroperitoneal abscess eventually causing scrotal abscess, which resolved on conservative treatment and drainage of the scrotal fecal abscess. Case Presentation. A 20-year-old male presented with gradually increasing noncolicky pain right side abdomen with nonprojectile vomiting, obstipation, and progressive abdominal distension. Clinically, the abdomen was tender with guarding over the right side with signs of inflammation on the right side back with no associated hernia. On conservative treatment, he was gradually improved but developed right side scrotal abscess a week later. CT abdomen showed a large retroperitoneal collection having multiple internal air lucencies, displacing ascending colon and caecum medically with discontinuity in the posterior wall of ascending colon. The large retroperitoneal collection was extending from right pararenal and posterior perihepatic soft tissue planes to the right iliac fossa and thigh. On drainage of the scrotal abscess, about 350 ml of fecal contents was evacuated. The patient gradually recovered and was discharged on conservative treatment with an uneventful 4-year follow-up.

Conclusion

Diagnosis of retroperitoneal perforation of the colon is often delayed due to the absence of peritoneal irritation. An extensively large retroperitoneal abscess may spread the infection to the scrotum and thigh due to extreme pressure, possibly by dissecting away the transversalis fascia through a deep ring along the side of the spermatic cord. Timely performed CT/MRI can avoid delay in the diagnosis of retroperitoneal abscess and further spread of infection.

Perforated adenocarcinoma of the colon within a scrotal hernia imaged by CT: case report and literature review

Colorectal cancer is one of the most common cancers in the developed countries, and colon cancer is well documented. However, it is very rare for a primary colon cancer to exist in a scrotal hernia, and even rarer for the scrotal hernia to perforate. Here, we describe an unusual case where a 75-year-old patient with a colon tumor that perforated in a scrotal hernia. The teaching point is to highlight the computed tomography scan imaging characteristics of this rare finding in patients with both abdominal and scrotal pain.

Pneumohernios due to perforated cecum in left Amyand's hernia

We report a case of incarcerated left indirect inguinal hernia in a male child which on exploration revealed the presence of free air and fecal matter containing fluid in the hernial sac. This is the second reported case of the presence of cecal perforation in left Amyand's hernia in pediatric age group and unique in the sense of the form of abnormal anatomy encountered per-operatively.