Giant inguinoscrotal hernia containing intestinal segments and urinary bladder successfully repaired by simple hernioplasty technique: a case report

Abstract

IntroductionGiant inguinoscrotal hernias are extremely rare nowadays, but they may still be encountered after years or even decades of neglect. Such hernias containing both bowel loops and urinary bladder have not been reported in the medical literature to date, to the best of our knowledge.Case presentationWe report a case of a 65-year-old Moroccan man who presented with giant right-sided and long-standing inguinoscrotal hernia with compromised quality of life due to walking difficulties and sexual discomfort. Computed tomography revealed a voluminous hernia sac containing small and large bowel loops, greater omentum, and urinary bladder. Surgical repair was done through the classical inguinal incision using the Lichtenstein tension-free hernioplasty technique. No debulking or abdominal enlargement procedure had to be performed, apart from a partial omentectomy.ConclusionsGiant inguinoscrotal hernia containing intestinal segments and urinary bladder is a challenging surgical disease. A Lichtenstein tension-free technique seems to be the best surgical procedure for both the patient and the operating surgeon. It should be used whenever possible in such cases.

Inguinoscrotal hernia containing the urinary bladder successfully repaired using laparoscopic transabdominal preperitoneal repair technique: A case report

“…In 1%–4% of adult patients with an inguinal hernia, the urinary bladder is found within the hernia ; those who are elderly, obese, or have prostatic hypertrophy are more prone to this complication. Many reports of inguinal hernias containing the urinary bladder describe repair using the open Lichtenstein method , but we chose to perform TAPP instead. Although laparoscopic hernia repair has advantages, such as less postoperative pain and an earlier recovery, serious complications such as organ damage and vascular injury occur more frequently than with open repair .…”

Treatment of a half century year old giant inguinoscrotal hernia. A case report

“…The aim of surgical therapy is to reduce the sac’s contents back in the abdominal cavity. This can be achieved with two ways: Forced reduction of the sac’s contents in the abdominal cavity (usually through the deep inguinal ring) [4] . Debulking of the hernia’s contents, which usually involves the resection of small bowel, colon or greater omentum [5] .…”

“…Forced reduction of the sac’s contents in the abdominal cavity (usually through the deep inguinal ring) [4] .…”

“…This maneuver could lead to wound dehiscence, inflammation or recurrence of the hernia, so the scrotal skin was left redundant; to act as a protection net in case there was a recurrence of the hernia due to increased intra-abdominal pressure postoperatively [4] . A double mesh was subsequently sutured in the posterior wall of the inguinal canal and behind the rectus muscle.…”

Giant Inguinoscrotal Hernia

“…2 Surgical complications from abrupt reduction of sizeable hernia contents into the peritoneal cavity include diaphragmatic dysfunction, bowel obstruction, wound dehiscence, and abdominal compartment syndrome. 1,3 Recurrence risk is elevated compared to typical inguinal hernias. 1 The patient declined imaging or surgical referral, as he was satisfied with his quality of life.…”