Duodenal rupture due to giant inguinal hernia: A case report

Abstract

Introduction: Giant inguinal hernia is unusual, and duodenal rupture accompanying it is particularly very rare and significantly hard to manage surgically.

Presentation of case: An 81-year-old man was admitted to our institution with upper abdominal pain. He had tenderness of the upper mid abdomen and a bilateral large inguinal hernia but he did not have pain in the inguinal-scrotal area. Computed tomography (CT) showed slight dilatation of the small bowel and stomach. There were no remarkable signs of incarceration of the inguinal hernia. Therefore, he was admitted to the internal ward. On the second day in hospital, he suddenly went into shock. CT revealed that there was free air and ascites in the inguinal hernia and therefore an emergency operation was performed. The tranverse colon, ascending colon, and ileum were incarcerated, and perfolation of the cecum was found. We also detected duodenal rupture at the inferior duodenal angle. We resected the terminal ileal (almost 90cm) and ileocecal area, followed by side-to-side anastomosis of duodenum and jejunum. We only repaired the peritoneum at the internal hernia ring. After the operation, despite intensive-care therapy, this patient passed away on the 18th postoperative day.

Discussion: The mesocolon and third portion of the duodenum were strongly pulled down into giant inguinal hernia, probably causing the rupture of the inferior duodenal angle.

Conclusion: Giant inguinal hernia possibly provokes duodenal rupture and therefore should definitively be repaired if feasible.

Keywords: A case report; Duodenal rupture; Giant inguinal hernia; Septic shock.

Fig. 1

An abdominal computed tomography scan.　This figure show slightly dilated stomach and jejunum, and large bilateral inguinoscrotal hernia containing small bowel, cecum, ascending colon, and sigmoid colon.

Fig. 2

Two days aftershow.

Fig. 3

There was perforation of cecum. Terminal ileum of about 100 cm from bauhin valve had become necrotic.

Fig. 4

Patient’s general condition was very severe due to septick shock. We used several antibiotic agents, vasopressure agent and continuous hemodiafiltration.

Fig. 5

CT scan showed superior mesentery artery and duodenum retracted to lower abdomen.