Strangulation and Necrosis of an Epiploic Appendage of the Sigmoid Colon in a Right Inguinal Hernia

Abstract

An epiploic appendage of the sigmoid colon is considered to be an unusual type of inguinal hernia content. The strangulation of a sigmoid colon appendage into a right inguinal hernia is exclusively rare. We present a case of an 81-year-old female patient with severe cardiovascular comorbidities who was urgently admitted after an episode of strangulation and subsequent spontaneous reduction of a right inguinal hernia. The condition of the patient was stable, and an urgent operation was not indicated for three days after admission. However, we had to operate because the hernia strangulation recurred. In the hernia sac, a free fatty body (a separated and saponified epiploic appendage of the colon) and a strangulated epiploic appendage of dolichosigmoid, with signs of necrosis, were found. Removal of the free fatty body and necrotic epiploic appendage and subsequent anterior-wall inguinal hernioplasty were successfully performed. In the world literature, this case may be the first report of a sigmoid epiploic appendage strangulation in a right inguinal hernia that is well documented by photography.

Epiploic Appendagitis in an Incarcerated Inguinal Hernia: A Case Report and Literature Review

“…Our case matched most of the studies mentioned above with regards to patient demographics, as the majority of cases were in men aged 60 and above [5][6][7][8]. The clinical presentation of pain and swelling was common to prior reports as well as our own.…”

A Rare Case of a Direct Incarcerated Inguinal Hernia Containing an Epiploic Appendage and a Literature Review

“…7 Epiploic appendages are located in the large bowel and can be found in inguinal hernia sacs, though this incident is quite rare and few cases have been reported. 13 These appendages are outpouchings of fatty tissue, covered by serosa that project into the peritoneal cavity and that are supplied by one or two small arteries. Due to the limited arterial blood supply, along with their pedunculated structure that allows increased movement, epiploic appendages are prone to torsion and ischemia or bleeding, which can also be caused by the thrombosis of the central vein.…”

“…However, in cases where the appendages become incarcerated in an irreducible inguinal hernia, an emergency surgery can be called for. 15 Despite the unlikelihood of direct hernia complications, there have been a few documented cases of strangulated direct hernias arising in various ways. One such case involved a life threatening bowel perforation, secondary to ischemic necrosis, which required emergent resection of the necrotic bowel.…”

Incarcerated Appendix Epiploica in Inguinal Hernia Sac: Treatment with Laparoscopic TAPP Approach—Report of a Rare Case

“…But, only Jain et al reported one such case on which laparoscopic TAPP was performed [6]. While many studies report sigmoid colon AE lodged within left inguinal hernia sac, there have been case reports where AE were seen in the right inguinal hernia sac [7]. Besides the commonly observed omentum or bowel loops, the hernia sac may also contain appendix vermiformis, Meckel's diverticulum, uterus, ovaries, fallopian tubes, AE, lipoma, or other organs [7].…”

“…While many studies report sigmoid colon AE lodged within left inguinal hernia sac, there have been case reports where AE were seen in the right inguinal hernia sac [7]. Besides the commonly observed omentum or bowel loops, the hernia sac may also contain appendix vermiformis, Meckel's diverticulum, uterus, ovaries, fallopian tubes, AE, lipoma, or other organs [7]. It is well known that the most common content of a strangulated inguinal hernia is a small bowel loop or part of the major omentum.…”