A patient with a giant inguinal hernia who presented with strangulated ileus caused by incarceration of the ileocecum and sigmoid colon

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  • 回盲部およびS状結腸が嵌頓し絞扼・穿孔した巨大鼠径ヘルニアの1例
  • 症例 回盲部およびS状結腸が嵌頓し絞扼・穿孔した巨大鼠径ヘルニアの1例
  • ショウレイ カイ モウブ オヨビ Sジョウ ケッチョウ ガ カントンシコウヤク ・ センコウ シタ キョダイ ソケイ ヘルニア ノ 1レイ

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Abstract

The patient was a 69-year-old man who required dialysis for chronic renal failure. Around 2009, he noticed a bulge in his left groin that gradually increased in size ; however, he did not seek treatment. In February 2011, he presented with abdominal pain and vomiting ; he was diagnosed on the following day as having an incarcerated hernia. The left groin was found to be swollen to the size of an infant's head and appeared red. Computed tomography (CT) revealed incarcerated intestinal loops in the left scrotum and free air. A diagnosis of incarcerated left inguinal hernia and intestinal rupture in the scrotum was made, and emergency surgery was performed. The ileocecum and the sigmoid colon were herniated and incarcerated in the left scrotum. The ileocecal intestinal segment was necrotized and perforated. After resection of the ileocecum, a left inguinal hernioplasty was performed using McVay's procedure, and an ileal stoma was constructed. After surgery, the patient became hemodynamically unstable, requiring endotoxin adsorption therapy and continuous hemodiafiltration under mechanical ventilation. Although a wound infection occurred subsequently, the patient's general condition improved. He was discharged on postoperative day 59. In regard to giant inguinal hernias, there are occasional reports of incarceration and strangulation of hernia contents that necessitate emergency surgery and intestinal resection. However, there are few reports of cases in which the ileocecum herniates to the left side, enters the scrotum together with the sigmoid colon, and becomes incarcerated, as occurred in our case.

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