An Incarcerated Inguinal Hernia Masking a Reactive Nodular Fibrous Pseudotumor: A Case Report

Abstract

A reactive nodular fibrous pseudotumor (RNFP) is a rare benign tumor that is related to previous abdominal surgery, injury, or inflammation, and in patients with a history of malignancy; it is easily misdiagnosed as tumor recurrence or metastasis. We discuss the case of an 80-year-old patient who presented to the emergency department with a large non-reducible inguinal hernia. The patient was taken to the operating room for an open hernia repair through an inguinal incision. Perioperative findings were a large left-sided inguinal hernia, which contained the sigmoid colon with a gross solid mass emerging from the bowel wall. The mass was infiltrating the left testicle and resection of the sigmoid colon, the mesentery, and the left testicle, without a primary anastomosis, was performed through the inguinal incision. A sigmoid stoma was installed and the abdominal wall was restored according to the Lichtenstein technique. The histopathology results revealed an RNFP arising from the sigmoid colon. To our knowledge, this is the first report of such a tumor created on the ground of chronic fibrosis from an inguinal hernia. Discovery of an RNFP during laparotomy for malignant tumors is generally reported in the literature, especially for patients with a history of cancer. Our report showcases that surgeons should remain vigilant regarding these tumors in patients with chronic inguinal hernias and masses found inside the hernia sacs.