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

TL;DR

A rare case of a right inguinal hernia causing a closed-loop bowel obstruction with the transverse colon was successfully treated with emergency surgery.

Contribution

This case report highlights the unusual presentation of transverse colon herniation leading to closed-loop obstruction and its successful management.

Findings

CT imaging confirmed transverse colon herniation causing closed-loop obstruction.

Emergency open hernia repair using a modified Shouldice technique with mesh was effective and complication-free.

The patient's recovery was uneventful, emphasizing the importance of prompt surgical intervention.

Abstract

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.

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