Inguinal Sac Abscess Masquerading as a Strangulated Inguinal Hernia after Antrectomy and Proximal Duodenectomy for Perforated Peptic Duodenal Ulcer

Abstract

Background: Patients who undergo surgery for a perforated duodenal ulcer are at risk of developing an intraabdominal abscess. Even in this setting, the possibility of developing an inguinal hernia sac abscess is rare. Case Presentation: We report the case of a 66-year-old male who underwent an antrectomy and proximal duodenectomy, truncal vagotomy, Billroth II gastrojejunostomy, and a Witzel tube jejunostomy for a recurrent perforated duodenal ulcer. Seven days after this operation, he developed symptoms concerning for a strangulated left inguinal hernia. At operation, a hernia sac abscess of Candida glabrata was identified and excision of the hernia sac and McVay herniorrhaphy were performed. Conclusion: An inguinal sac abscess may develop in patients who have undergone surgery for perforated peptic ulcers and can masquerade as a strangulated inguinal hernia. In the post-operative period, it should be considered in patients who develop an acute onset of groin pain. Definitive management should include excision of the sac and herniorrhaphy without a mesh prosthesis to limit the risk of a chronic wound infection.