Long-Standing, Giant, Right-Sided Inguinal Hernia Containing the Right Colon and Greater Omentum: A Case Report

TL;DR

A rare case of a long-standing giant right-sided inguinal hernia containing parts of the colon and omentum is reported, highlighting the challenges in diagnosis and surgical management.

Contribution

This case report adds to the limited literature on giant inguinal hernias with unusual contents and emphasizes the importance of multidisciplinary care.

Findings

The hernia sac contained the right colon, transverse colon, and greater omentum.

Postoperative complications included a scrotal hematoma requiring drainage.

Preoperative respiratory rehabilitation and meticulous surgical technique improved outcomes.

Abstract

Giant inguinal hernias are rare, long-standing conditions characterized by massive herniation of intra-abdominal organs into the scrotum. Their chronicity, unusual contents, and associated comorbidities make diagnosis and surgical management particularly challenging. We report the case of a 63-year-old man with a right-sided inguinal hernia present for 39 years. His medical history included hypertension, ischemic heart disease, hypercholesterolemia, and diabetes mellitus. Preoperative assessment included recommendations for respiratory rehabilitation to optimize pulmonary function. During surgery, the hernia sac was found to contain the right colon, transverse colon, and greater omentum. Resection of the greater omentum was performed, followed by reduction of the hernia contents and repair using the Lichtenstein technique. The postoperative course was complicated by a scrotal hematoma, which required drainage and placement of three drains. The patient recovered well following appropriate management. Giant inguinal hernias pose significant intraoperative and postoperative risks, including increased intra-abdominal pressure, respiratory compromise, and hematoma formation. Careful preoperative planning, meticulous surgical technique, and individualized management are crucial for successful outcomes. Preventive strategies such as preoperative respiratory prophylaxis may further reduce postoperative complications. In addition, increasing public awareness is important to encourage earlier presentation, reduce the risk of complications, and minimize stigmatization associated with the condition. Giant inguinal hernias remain a rare but challenging surgical entity. Early diagnosis, timely surgical intervention, and multidisciplinary perioperative care are essential to achieving safe outcomes and improving quality of life.

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