The stomach as a content of inguinal and femoral herniæ

Abstract

THE stomach is a rare occupant of the sac of an inguinal hernia and is yet more rarely found in a femoral hernia. The discovery of the stomach in the inguinal hernia of a patient of ours led to a prolonged but fascinating search of world literature in an effort to trace all the recorded cases. Towards the end of this search one of us was asked to see a patient with a very large femoral hernia and a barium meal confirmed our suspicions that the stomach might be in the sac. We are able, therefore, to report two new cases-one of stomach in an inguinal hernia and one of stomach in a femoral hernia, together with a summary of the cases already published. STOMACH IN INGUINAL HERNIA CASE REPORTHISTORY.--. A., a man of 61, was sent into hospital by his doctor as a case of strangulated left inguinal hernia. He was a house painter and had had a left inguinal hernia for about forty years. He had worn a truss intermittently. There was no history of dyspepsia nor had he noticed any alteration in the size of his large hernia after eating or drinking. The hernia had-always been reducible up to the day before admission to hospital.He had only worked for one month during the past year because of bronchitis and he had been in bed for the last two months with dyspncea and oedema of the feet. Six weeks previously he had a right-sided pulmonary embolus.Two days before admission he vomited dark fluid on about ten occasions but had a normal bowel action. The day before admission he vomited continuously and was not able to reduce his hernia, which became painful. There was no abdominal pain.ON EXAMINATION.-A frail looking man, who was pale, cyanosed, very dyspnoeic, and constantly vomiting. No edema of legs.Abdomen : Markedly distended and tense. Very large left scrota1 hernia, which was neither tense nor tender and varied in size as he strained to vomit. The hernia could not be reduced.Chest : Very poor expansion, with scattered rhonchi and basal riles.Cardiovascular System: The pulse was of poor volume. Rhythm regular and apex beat in the anterior axillary line. B.P. 120/80.TREATMENT.-A Ryle's tube was passed and aspirated 137 02. (3.89 1.) of dark fluid, smelli?g of bile, and some of which had the 'coffee grounds appearance. The aspiration produced a dramatic improvement, the abdomen being greatly reduced in size and quite lax. The hernia could be reduced and the left external ring was found to admit three fingers and the right two. He was much less dyspnoeic and the pulse volume improved.He was put on an intravenous drip and gastric suction till the fourth day, when the aspirations were of such quantity and quality that oral feeding was commenced. A straight radiograph of the abdomen had not shown any fluid levels. Three days later, as he was feeling nauseated, I tube was passed and a litre of brown fluid aspirated It was then thought that he had wic stenosis rather than a mechanical obstruction, and ?m the stomach. the hernia appeared to be unrelated to the symptoms for which he was admitted. However, the following was reported aft...

Gastric Outlet Obstruction from Stomach-Containing Groin Hernias: Case Report and a Systematic Review

“…The first comprehensive review of SCOGH was published by Davey and Strange in 1954 [ 25 ]. This manuscript accounted for 34 inguinal and three femoral hernias and was inclusive of the prior 150 years and up to the date of publication [ 25 ].…”

“…Subsequently, Cochrane Library, Google, Google Scholar, and ResearchGate were utilized to search and acquire reports that were new and/or unavailable from the previous databases. Further manuscripts were identified by close examination of the references of the index papers and main reviews on this subject [ 24 , 25 , 26 ]. These manuscripts were included in our review if they were appropriate references and did not duplicate our original findings of patients with SCOGH reviewed elsewhere.…”

Stomach Within a Large Inguinal Hernia

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Bilateral inguinoscrotal hernia with gastric contents and subsequent perforation: Lessons in operative management

“…In this case the patient was acutely unwell and required distal gastrectomy due to perforation of the stomach. It is thought that the descent of the greater omentum into the large hernial sac draws the stomach down [ 7 ], which in turn stresses the peritoneal attachments and vasculature putting it at high risk of perforation. Gastric perforation has been regularly reported in other cases of inguinoscrotal hernias containing stomach and seems to be a recurrent issue.…”