Giant Inguinoscrotal Hernia—Report of a Rare Case With Literature Review

Abstract

Massive inguinoscrotal hernias extending below the midpoint of the inner thigh, in the standing position constitute giant inguinoscrotal hernias. We report a patient who presented with giant right inguinal hernia with bilateral hydrocele for 25 years. He had no cardiorespiratory illnesses. He was taken up for surgery under general anesthesia after preoperative respiratory exercises. Sliding hernia with entire greater omentum, small bowel, and appendix as contents was identified. Meshplasty after omentectomy with bilateral subtotal excision of sac, right orchidectomy, and scrotoplasty were done. Giant inguinoscrotal hernias pose significant problems while replacing bowel contents because of the increase in intraabdominal and intrathoracic pressures. Recurrence is another complication seen after successful surgical management. Various techniques such as preoperative pneumoperitoneum, debulking abdominal contents with extensive bowel resections, or omentectomy and phrenectomy have been tried. Postoperative elective ventilation is also needed in many cases. We describe simple reduction with omentectomy as a viable technique in this patient. He did not need elective ventilation due to preoperative respiratory exercises and preparation and review of the literature.

Surgical management of a giant inguinoscrotal hernia: A case report

“…Scrotoplasty with removal of redundant scrotal skin has been successfully performed at the time of hernia repair to prevent the development of a postoperative scrotal hematoma and lymphedema in several cases. [1,13] In the majority of patients patients, the redundant scrotal skin is left intact and allowed to naturally shrink over time due to retraction of the dartos muscle. [4,[14][15][16][17] If sufficient retraction does not occur in the postoperative period, scrotoplasty can be performed successfully at a later date.…”

Giant Inguinoscrotal Hernia

“…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. …”

“…A giant inguinoscrotal hernia extends below the midpoint of the inner thigh with the patient standing. 1 The natural history is scrotal expansion as omentum enters, followed by small bowel, colon, and possibly other organs. 2 Complications include urinary retention, leakage, infection, skin maceration, hernia incarceration, and social isolation.…”

“…2 Complications include urinary retention, leakage, infection, skin maceration, hernia incarceration, and social isolation. 1 Contrast-enhanced computed tomography followed by open surgical repair is recommended for all giant hernias. 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.…”

“…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.…”