# Pancreas and duodenum herniation in a giant inguinal hernia sac in a patient with severe scoliosis: a rare case report

## TL;DR

A rare case of a giant inguinal hernia containing the pancreas and duodenum is reported in a patient with severe scoliosis.

## Contribution

This case report presents an exceptionally rare herniation of retroperitoneal organs in a patient with complex anatomical deformities.

## Key findings

- The pancreatic head and duodenum herniated into a giant inguinal hernia sac.
- Altered retroperitoneal geometry due to scoliosis contributed to the herniation.
- Multiple left hepatic duct calculi were found, possibly linked to chronic duodenal displacement.

## Abstract

Giant inguinal hernias (GIHs) are rare clinical entities, typically containing omentum or small bowel. Involvement of retroperitoneal organs, such as the pancreas and duodenum, is exceedingly uncommon due to their fixed anatomical positions. We report a unique case of a 52-year-old male with a longstanding right GIH and severe scoliosis, in whom preoperative imaging and surgical exploration revealed herniation of the pancreatic head and duodenum into the hernia sac. Contributing factors included altered retroperitoneal geometry from spinal curvature, reduced abdominal wall tone, and congenital right hip displacement with associated functional limitation. Incidental findings of multiple left hepatic duct calculi raised concerns for biliary stasis due to chronic duodenal displacement. This case highlights the importance of considering atypical hernia content in patients with longstanding hernias and complex musculoskeletal deformities, and underscores the role of comprehensive imaging and multidisciplinary assessment in surgical planning.