|Year : 2014 | Volume
| Issue : 4 | Page : 281-282
Incarcerated right inguinal hernia containing sigmoid colon: A rare case report
Amit Mahajan, Anil Luther
Department of Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
|Date of Web Publication||16-Oct-2014|
Department of General Surgery, Christian Medical College, Ludhiana - 141 001, Punjab
Source of Support: None, Conflict of Interest: None
Incarcerated inguinal hernia is a common diagnosis in patients presenting with a painful and non-reducible groin mass. Although the diagnosis is usually made by physical examination, the content of the hernia sac and the extent of the following operation may vary. The usual finding is a segment of small bowel and less commonly large bowel. However, an unusually large number of pathological processes have been recorded in literature, which also present in this manner. Except in sliding hernia, the sigmoid colon is uncommonly found in an inguinal hernia, especially on the right side. We present an extremely rare case of an incarcerated right inguinal hernia containing the sigmoid colon and review relevant literature.
Keywords: Incarcerated inguinal hernia, right side, sigmoid colon
|How to cite this article:|
Mahajan A, Luther A. Incarcerated right inguinal hernia containing sigmoid colon: A rare case report. CHRISMED J Health Res 2014;1:281-2
|How to cite this URL:|
Mahajan A, Luther A. Incarcerated right inguinal hernia containing sigmoid colon: A rare case report. CHRISMED J Health Res [serial online] 2014 [cited 2017 Sep 24];1:281-2. Available from: http://www.cjhr.org/text.asp?2014/1/4/281/143006
| Introduction|| |
Protrusion of any viscus (covered by a peritoneal sac) through the inguinal region of abdominal wall is known as inguinal hernia. Inguinal hernia is principally of two types- oblique or indirect and direct. The content of the hernial sac may vary from a piece of omentum to small or large intestine; ileum being commonest. Other abdominal viscera may rarely be involved, like appendix, stomach, Meckel's diverticulum etc. On the right side, caecum, appendix, ascending colon are involved and on the left sigmoid colon. There may be complications of inguinal hernia like irreducible hernia, obstructive hernia or strangulated and inflammed hernia. Blood supply to a herniated viscus in compromised in strangulated hernia and it is one of the most common surgical emergencies. Although the diagnosis is usually made by physical examination, the content of the hernia sac and the extent of the following operation may vary and that is found only at the time of surgery. We present an extremely rare case of a strangulated left sided inguinal hernia containing the sigmoid colon and the relevant review of literature.
| Case Report|| |
A 72-year-old heavy truck driver presented to the casualty with complaints of pain and inability to reduce a right-sided inguinal hernia that had been present since 2 years and had been reducing spontaneously on lying supine. There was a previous history of surgery for left-sided inguinal hernia 4 years ago. On examination, patient's abdomen was soft, non-tender with sluggish bowel sounds. In the right inguinal area, there was a large incomplete irreducible hernia, tender on palpation and it had feeble gurgling sounds on auscultation. Chest x-ray was normal. An abdomen ultrasound was done, which showed the hernia sac containing bowel loops with reduced peristalsis. The patient was posted for emergency exploration of the inguinal region. Intraoperatively, the hernia sac was found to contain an odematous bowel loop with appendices epiploicae, which was identified as redundant sigmoid colon [Figure 1]. The contents of the hernia were reduced and right inguinal mesh hernioplasty was done. Post-operative period was uneventful, and the patient was discharged in satisfactory condition and is being followed up in the outpatient department.
|Figure 1: Hernial sac containig sigmoid colon as content in the right side of inguinal region|
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| Discussion|| |
Inguinal hernias are relatively common in the elderly with an estimated prevalence 6%.  Incarceration of inguinal hernia occurs in approximately 10% of cases which in turn can lead to intestinal obstruction, strangulation, and infarction.  Among these complications, strangulation is the most serious with potentially lethal sequelae.  The content of inguinal hernias varies widely. In most cases, the small intestine and omentum are usually contained in the hernia sac, but an ovulating ovary,  liposarcoma of the spermatic cord,  spermatic cord hematoma,  pancreatic pseudocyst,  blood from a ruptured spleen,  and splenic gonadal fusion in a child  have also been reported. Inguinal hernia sacs in 0.5% of cases contain malignancies either of saccular origin or generating from the herniated organ, usually sigmoid, caecum, and other parts of colon. 
In our case, the content of the hernia sac was the incarcerated loop of sigmoid colon probably due to redundancy. Due to anatomical considerations, the sigmoid colon is commonly found to herniate through abdominal defects at the left inguinal region, especially as a sliding hernia. The sigmoid colon as a content of a right side inguinal hernia is extremely rare.
Inguinal hernia is a common clinical condition that usually has limited differential diagnostic spectrum and its repair is simple in the hands of experienced surgeon. In rare cases though, hernias may pose a great surprise, not only due to their content but also for their difficulty in management. Despite universal acceptance of the value of elective hernia repair, many patients present with incarceration or strangulation, which are associated with significant morbidity and mortality due to which elective repair of inguinal hernias should be done whenever possible.
| References|| |
Slater R, Amatya U, Shorthouse AJ. Colonic carcinoma presenting as strangulated inguinal hernia: Report of two cases and review of the literature. Tech Coloproctol 2008;12:255-8.
McFadyen BV Jr, Mathis CR. Inguinal herniorraphy: Complications and recurrences. Semin Laparosc Surg 1994;1:128-40.
Gallegos NC, Dawson J, Jarvis M, Hobsely M. Risk of strangulation in groin hernias. Br J Surg 1991;78:1171-3.
Golash V, Cummins RS. Ovulating ovary in an inguinal hernia. Surgeon 2005;3:48.
Hassan JM, Quisling SV, Melvin WV, Sharp KW. Liposarcoma of the spermatic cord masquerading as in incarcerated inguinal hernia. Am Surg 2003;69:163-5.
McKenney MG, Fietsam R Jr, Glover JL, Villalba M. Spermatic cord hematoma: Case report and literature review. Am Surg 1996;62:768-9.
Erzurum VZ, Obermeyer R, Chung D. Pancreatic pseudocyst masquerading as an incarcerated inguinal hernia. South Med J 2000;93:221-2
Sherman HF. The inguinal hernia: Not always straightforward, not always a hernia. J Emerg Med 1989;7:21-4
Tank ES, Forsyth M. Splenic gonadal fusion. J Urol 1988;139:798-9.
Boormans JL, Hesp WL, Teune TM, Plaisier PW. Carcinoma of the sigmoid presenting as a right inguinal hernia. Hernia 2006;10:93-6.