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Sujino H, Gon H, Shimoda Y, Takishita C, Enomoto M, Tachibana S, Kasuya K, Nagakawa Y. Incomplete bowel obstruction caused by sigmoid colon cancer in an inguinal hernia: a case report. Surg Case Rep 2024; 10:99. [PMID: 38656705 PMCID: PMC11043287 DOI: 10.1186/s40792-024-01874-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Most colon cancers that develop in the intestinal tract within the inguinal hernia sac are identified by incarceration. However, treatment methods for these cases vary depending on the pathology. Cases showing perforation or abscess formation require emergency surgery for infection control, while cases with no infection generally involve oncological resection, with laparoscopic surgery also being an option. We encountered a case of Incomplete bowel obstruction secondary to sigmoid colon cancer within the hernial sac. We report the process leading to the selection of the treatment method and the surgical technique, along with a review of the literature. CASE PRESENTATION A 79-year-old man presented to our hospital complaining of a left inguinal bulge (hernia) and pain in the same area. The patient had the hernia for more than 20 years. Using computed tomography, we diagnosed an incomplete bowel obstruction caused by a tumor of the intestinal tract within the hernial sac. Since imaging examination showed no signs of strangulation or perforation, we decided to perform elective surgery after a definitive diagnosis. After colonoscopy, we diagnosed sigmoid colon cancer with extra-serosal invasion; however, we could not insert a colorectal tube. Although we proposed sigmoid resection and temporary ileostomy, we chose the open Hartmann procedure because the patient wanted a single surgery. For the hernia, we simultaneously used the Iliopubic Tract Repair method, which does not require a mesh. Eight months after the surgery, no recurrence of cancer or hernia was observed. CONCLUSIONS We report a case of advanced sigmoid colon cancer with a long-standing inguinal hernia that later became incomplete bowel obstruction. Although previous studies have used various approaches among the available surgical methods for cancer within the hernial sac, such as inguinal incision, laparotomy, and laparoscopic surgery, most hernias are repaired during the initial surgery using a non-mesh method. For patients with inguinal hernias that have become difficult to treat, the complications of malignancy should be taken into consideration and the treatment option should be chosen according to the pathophysiology.
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Affiliation(s)
- Hiroki Sujino
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Hideki Gon
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Yota Shimoda
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Chie Takishita
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Masanobu Enomoto
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Shingo Tachibana
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
| | - Kazuhiko Kasuya
- Department of Surgery, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama, 335-0023, Japan.
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan.
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan
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Zhang J, Tang Y, Wu X, Wang G, Li T. Sigmoid Colon Cancer Masquerading as a Right Incarcerated Inguinal Hernia: A Case Study and Literature Review. Front Surg 2022; 9:832771. [PMID: 35252338 PMCID: PMC8891130 DOI: 10.3389/fsurg.2022.832771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background Indirect inguinal hernia and sigmoid colon cancer are both common diseases, but carcinoma within the hernia sac is rare. We present a case of sigmoid colon cancer masquerading as a right incarcerated inguinal hernia. Since such a presentation is rare, and the correct diagnosis is usually made intraoperatively, there is still no consensus on the best treatment modality for such patients. Case Presentation A 70-year-old man presented to our hospital on September 20, 2020, with a right inguinal mass that had been painful for half a month, accompanied by symptoms of difficult defecation. The bulge was originally found at least 60 years before admission. There was no pain at the time; however, the mass enlarged progressively during the last 3 years. The right scrotum and groin area were obviously enlarged (~20 × 20 cm) and tender. Inside the scrotum, a circumscribed medium-hard mass (diameter 5 cm) that was palpable, with ill-defined borders and translational mobility was detected. The computed tomography (CT) scan showed a right blood vessel-containing strangulated inguinal hernia; the sigmoid colon showed focal wall thickening as it was in proximity to the inguinal hernia. Based on the biopsy results, a pathologic diagnosis of high-grade intraepithelial neoplasia was made. The preliminary diagnosis was that of sigmoid carcinoma and right incarcerated inguinal hernia. Emergency laparoscopic exploration, open sigmoid radical resection andright inguinal hernia repair were performed under general anesthesia. The patient recovered successfully and was discharged 1 week after the operation. One month after surgery, no discomfort and signs of recurrence were found. Conclusions The combination of colorectal cancer and inguinal hernia is uncommon, and detailed preoperative physical examination and imaging studies may contribute to the establishment of a correct diagnosis. The selection of appropriate surgical methods ensures good therapeutic results.
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Affiliation(s)
- Jianfeng Zhang
- The Second Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yujie Tang
- School of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Xueliang Wu
- Department of General Surgery, The First Affiliated Hospital of Hebei North University, Shijiazhuang, China
| | - Guiying Wang
- Gastrointestinal Surgery Department, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Guiying Wang
| | - Tian Li
- School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
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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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