A case of Colon Perforation in an Incarcerated Inguinal Hernia

DOI 7 Citations 21 References

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  • 鼠径ヘルニア嵌頓による大腸穿孔の1例

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A 72-year-old man undergoing radiation therapy and chemotherapy chemoradiotherapy for lung cancer and metastatic brain cancer developed intermittent abdominal pain with high fever. Subcutaneous emphysema was observed in the right lower abdomen, and the scrotum was enlarged to the size of the head of a newborn, with severe tenderness. Abdominal CT showed free air in the peritoneal cavity and intestinal herniation into the scrotum. Intestinal perforation in the incarcerated inguinal hernia was diagnosed and emergency operation was performed. The caecum and ascending colon were incarcerated in the inguinal canal and the ascending colon was perforated, causing the fecal contents to leak out into the peritoneal cavity. We performed resection of the incarcerated colon and ileostomy. The hernia sac was difficult to separate because of adhesion, which necessitated excision of the testicle as well. However, successful combined-modality therapy enabled the patient to be transferred to the Department of Internal Medicine on day 51 after the operation. Only nine cases of incarcerated inguinal hernia of the caecum have been reported in Japan. As for the cases of perforation of the colon in an incarcerated hernia, as few as 8 cases have been reported so far : 4 of these cases showed herniation of the caecum. Incarcerated inguinal hernias of the caecum can be more easily perforated than those of the rest of the intestine, suggesting the need for particular caution to be exercised in these cases.

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