Published online Jan 16, 2023. doi: 10.12998/wjcc.v11.i2.401
Peer-review started: September 25, 2022
First decision: October 18, 2022
Revised: November 11, 2022
Accepted: December 19, 2022
Article in press: December 19, 2022
Published online: January 16, 2023
Processing time: 108 Days and 19.7 Hours
Giant inguinoscrotal hernias are huge inguinal hernias that extend below the midpoint of the inner thigh in the standing posture. Giant inguinoscrotal hernias are rare in developed countries because of their better medical resources and early treatment. However, they can develop in patients who refuse surgery or ignore their condition. Intervention is inevitable because strangulation and organ perforation can occur, leading to peritonitis and sepsis. Common surgical approaches include open abdominal and inguinal approaches or a combination of both.
We present the case of a 73-year-old man who visited our emergency department with a huge mass in his left scrotum and septic complications. Abdominal computed tomography revealed a large left inguinoscrotal hernia that contained small bowel loops and the colon. Emergency surgical intervention was performed immediately because intestinal strangulation was highly suspected. The operative repair was performed using a combination of mini-exploratory laparotomy and the inguinal approach. The incarcerated organs, which included the ileum and sigmoid colon, had relatively good intestinal perfusion without perforation or ischemic changes. They were successfully reduced into the abdomen, and bowel resection was not necessary. A tension-free prosthetic mesh was used for the hernia repair. Two weeks after the initial surgery, and with adequate antimicrobial therapy, the patient recovered and was discharged from our hospital. No evidence of hernia relapse was noted during the outpatient follow-up examination 3 mo after surgery.
Emergency surgery involving combined mini-exploratory laparotomy and the inguinal approach should be performed for serious incarcerated giant inguinoscrotal hernias.
Core Tip: Giant inguinoscrotal hernias are defined as hernias extending below the midpoint of the inner thigh of the patient in the standing position. Symptoms may vary, and serious complications, including intestinal obstruction and strangulation, may cause peritonitis and sepsis. Emergency surgery should be performed because of the risks of strangulation, perforation, and progressive necrosis. In this case, it was surprising to find the simultaneous existence of the ileum and sigmoid colon in the large inguinal hernia sac. The use of the inguinal approach combined with mini-exploratory laparotomy for giant hernial repair is beneficial and should be considered.