# Straining induced spontaneous bowel transection in a patient with incarcerated inguinal hernia with cryptorchidism: A case report

## TL;DR

A 40-year-old man with an incarcerated hernia and undescended testicle experienced rare spontaneous bowel transection due to straining, highlighting a new clinical observation.

## Contribution

First reported case of straining-induced spontaneous bowel transection in incarcerated inguinal hernia with cryptorchidism.

## Key findings

- Spontaneous bowel transection occurred due to straining in an incarcerated hernia with edematous bowel.
- Intraluminal pressure from straining can reach levels sufficient to cause bowel transection in such cases.
- Undescended testis in adults is at higher cancer risk, and fertility restoration is unlikely after orchidopexy.

## Abstract

The pooled prevalence of inguinal hernia worldwide is reported as 7.7 %. Out of all inguinal hernia cases, 10 % of cases get incarcerated whereas strangulation occurs in 0.29 % to 2.9 % of cases. The mortality rate of strangulated inguinal hernia is 2.6 % to 9 %. Although cough-induced spontaneous bowel transection in incarcerated inguinal hernia has been reported, straining induced spontaneous bowel transection has never been reported in the literature.

40 year male presented with irreducible swelling in right inguinoscrotal region, vomiting and unable to pass stool/flatus for 4 days. On examination, there was irreducible swelling at right inguinoscrotal region, separately palpable left testis and non-palpable right testis with signs of peritonitis. On inguinoscrotal exploration, the hernial sac contained 10 ml of toxic fluid with a viable but spontaneously transected ileal loop. So, hand-sewn ileoileal anastomosis with darning repair with right orchidectomy was done.

An intraluminal pressure of 150–260 mm of Hg is required for bowel transection. In incarcerated hernia, bowel loops are edematous, and repeated episodes of straining during defecation can lead to an elevation of intraluminal pressure up to 230 mm of Hg, which is enough to cause transection of the edematous bowel.

In incarcerated hernia, since the bowels are edematous, even repeated episodes of coughing or straining can cause bowel transection. Untreated undescended testis is at higher risk of developing malignancy after 10 years of age. Similarly, restoration of fertility is not seen even on orchidopexy. So, orchidectomy is recommended in adult.

•In incarcerated hernia, bower transection after trauma is common.•But in incarcerated hernia, bowel transection following non traumatic event like coughing or straining is rare.•Intraluminal pressure of 150-260 mm of Hg is required for transection of bowel.•In incarcerated hernia, since the bowels are edematous, even non traumatic events may cause transection of bowel.

In incarcerated hernia, bower transection after trauma is common.

But in incarcerated hernia, bowel transection following non traumatic event like coughing or straining is rare.

Intraluminal pressure of 150-260 mm of Hg is required for transection of bowel.

In incarcerated hernia, since the bowels are edematous, even non traumatic events may cause transection of bowel.