Sigmoid Colon Cancer Masquerading as a Right Incarcerated Inguinal Hernia: A Case Study and Literature Review

Abstract

BackgroundIndirect inguinal hernia and sigmoid colon cancer are both common diseases, but carcinoma within the hernia sac is rare. We present a case of sigmoid colon cancer masquerading as a right incarcerated inguinal hernia. Since such a presentation is rare, and the correct diagnosis is usually made intraoperatively, there is still no consensus on the best treatment modality for such patients.Case PresentationA 70-year-old man presented to our hospital on September 20, 2020, with a right inguinal mass that had been painful for half a month, accompanied by symptoms of difficult defecation. The bulge was originally found at least 60 years before admission. There was no pain at the time; however, the mass enlarged progressively during the last 3 years. The right scrotum and groin area were obviously enlarged (~20 × 20 cm) and tender. Inside the scrotum, a circumscribed medium-hard mass (diameter 5 cm) that was palpable, with ill-defined borders and translational mobility was detected. The computed tomography (CT) scan showed a right blood vessel-containing strangulated inguinal hernia; the sigmoid colon showed focal wall thickening as it was in proximity to the inguinal hernia. Based on the biopsy results, a pathologic diagnosis of high-grade intraepithelial neoplasia was made. The preliminary diagnosis was that of sigmoid carcinoma and right incarcerated inguinal hernia. Emergency laparoscopic exploration, open sigmoid radical resection andright inguinal hernia repair were performed under general anesthesia. The patient recovered successfully and was discharged 1 week after the operation. One month after surgery, no discomfort and signs of recurrence were found.ConclusionsThe combination of colorectal cancer and inguinal hernia is uncommon, and detailed preoperative physical examination and imaging studies may contribute to the establishment of a correct diagnosis. The selection of appropriate surgical methods ensures good therapeutic results.

A Rare Case of Perforated Caecal Cancer Disguised as a Strangulated Right Inguinoscrotal Hernia

“…Only a small number of such cases have been published worldwide, with approximately 23 cases published in the last 20 years (2003-2023) [7][8][9]. In a study by Zhang et al, the majority of the lesions were located within a left inguinal hernia (75%) and the most common pathology was sigmoid cancer (82.5%) [7]. The lesion was mainly located in the sigmoid colon [7].…”

“…In a study by Zhang et al, the majority of the lesions were located within a left inguinal hernia (75%) and the most common pathology was sigmoid cancer (82.5%) [7]. The lesion was mainly located in the sigmoid colon [7]. Three additional cases where the lesion was identified in the cecum have been reported [8].…”

“…Our patient had a strangulated right inguinoscrotal hernia that had been present for several years and contained the caecum, ascending colon, and terminal ileum. Of note, 50% of the cases are only diagnosed intraoperatively [7]. Proper diagnosis is crucial to achieving optimal outcomes, and delayed or incorrect diagnosis carries the risk of incomplete tumor excision [6].…”

“…The treatment should combine both hernia repair and careful oncological resection of the affected bowel, with or without anastomosis and stoma formation [6,7]. The operation can be performed with minimally invasive techniques; however, in the emergency setting of a strangulated hernia, open surgery is preferred [7]. The approach can involve either an abdominal or inguinal incision, or both [7].…”

“…The operation can be performed with minimally invasive techniques; however, in the emergency setting of a strangulated hernia, open surgery is preferred [7]. The approach can involve either an abdominal or inguinal incision, or both [7]. The use of mesh is encouraged in the repair of scrotal hernias, except for cases with contamination, where suture repair may be preferred [10].…”