A Massive Sliding Inguinal Hernia Containing the Entire Right Colon With Caecal Perforation: A Rare Surgical Challenge

TL;DR

A 75-year-old man with a rare massive inguinal hernia containing his entire right colon and a perforation required emergency surgery and recovered with minor complications.

Contribution

This case report highlights a rare surgical scenario involving a massive hernia with caecal perforation and its successful management.

Findings

A massive inguinal hernia containing the entire right colon was diagnosed with caecal perforation and abscess formation.

Emergency surgery included right hemicolectomy, ileostomy, and abscess drainage, leading to recovery with minor complications.

The patient was discharged after a week with a surgical site infection (SSI) grade 1.

Abstract

Hernias of the abdominal wall result from an area of weakness or defect in the abdominal wall, specifically in the area between the ribs and the hips. It can appear anywhere across the abdominal wall. The most common type of hernia is inguinal, which affects the groove between the abdomen and thigh. We discuss the case of a 75-year-old male who was admitted to the hospital after presenting with a large right-sided inguinoscrotal hernia, which had been gradually growing for the last three years. The patient had acute pain, hard swelling, and redness for the past three days. The general assessment revealed a large irreducible hernia, which was tender in the area of erythema. An emergency CT of the abdomen and pelvis (CTAP) demonstrated a perforated ascending colon with the formation of abscesses within the hernia.

The management involved an exploratory laparotomy, which showed evidence of a strangulated hernia; there was extensive ischaemia and congestion of the terminal ileum, cecum, appendix, ascending colon, and omentum. The surgical interventions included right hemicolectomy with ileostomy, drainage of the abscess in the abdominal wall, and hydrocelectomy. Postoperatively, the patient remained in the ICU for two days after the surgery; he developed a minor complication (surgical site infection (SSI) grade 1) and was later transferred to the ward and discharged after a week.

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