Unusual diagnoses presenting as incarcerated inguinal hernia: a case report and review of the literature

Bunting, David; Harshen, Raj; M, Ravichandra; Ridings, Philip C.

doi:10.1111/j.1742-1241.2006.00862.x

Cited by 24 publications

(14 citation statements)

References 8 publications

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“…Contents of the hernia sac such as neoplastic colonic obstruction, 1 obstructed colon, 2 perforated colonic diverticulum 3 and diverticulitis 4 have all been reported to date. However, such a presentation of the entire hepatic flexure in an inguinal hernia has not been described previously.…”

Section: Discussionmentioning

confidence: 99%

Obstructed hepatic flexure contained in a right-sided inguinoscrotal hernia resulting in caecal perforation

Skelly

Neill

2013

annals

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Southern Health and Social Care Trust, UK aBstract Inguinal hernia often presents as an emergency with obstruction and subsequent strangulation. We report a unique case where an inguinoscrotal sliding type hernia contained the entire hepatic flexure as its lead point, resulting in acute colonic obstruction and caecal wall perforation.Inguinal hernia is one of the recognised dynamic, extramural causes of intestinal obstruction, where peristalsis works against a physical barrier. Initially, proximal peristalsis increases to overcome the obstruction. When the obstruction is not relieved, the proximal segment dilates, causing reduction in peristaltic strength, resulting in flaccidity and paralysis. Further proximal distension results from gas and fluid accumulation. In the setting of complete obstruction, perforation from back pressure on the proximal segment is inevitable with time. We report a case of an inguinoscrotal sliding type hernia with the hepatic flexure of the colon and omentum as its lead point, resulting in acute colonic obstruction and caecal wall 'pistol shot' perforation. case historyA 63-year-old man with a history of chronic obstructive pulmonary disease, hypertension and ischaemic heart disease presented with a 3-day history of abdominal distension and vomiting, with absolute constipation for 5 days. He had had no previous abdominal surgery. A non-tender large irreducible right-sided inguinoscrotal hernia was found, with concomitant tenderness in the left iliac fossa. Demonstrating tachycardia, tachypnoea and hypotension, he received fluid resuscitation, and was investigated further with plain abdominal radiography and rigid sigmoidoscopy. The radiography found acute colonic distension (Fig 1). The rigid sigmoidoscope was inserted to 18cm from the anal verge. This did not demonstrate a cut-off point, therefore making diagnosis of sigmoid volvulus unlikely.

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Section: Discussionmentioning

confidence: 99%

Obstructed hepatic flexure contained in a right-sided inguinoscrotal hernia resulting in caecal perforation

Skelly

Neill

2013

annals

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“…Several important conditions may masquerade in this way, including ruptured ectopic pregnancy (Prasannan et al, 2004), ruptured abdominal aortic aneurysm, and liposarcoma of the spermatic cord (Bunting et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

A problem in diagnostic imaging

et al. 2010

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Many pathological processes can present as a swelling in the groin. We present a case of complex, ruptured pyonephrosis causing a psoas collection, which in turn presented clinically as an apparent right "incarcerated inguinal hernia." The patient was successfully treated with antibiotics and ultrasound-guided drainage of the abscess. The anatomical basis of the inguinal presentation of this complex pyonephrosis can be understood in the arrangement of the renal (Gerota's) fascia.

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“…1–3 Laparoscopic techniques are being increasingly used in the repair of inguinal hernia. Aside from confirming the primary hernia and finding additional unsuspected hernias, 4 laparoscopy offers the potential advantage of identifying other pathologies.…”

Section: Introductionmentioning

confidence: 99%