Incarcerated sigmoid colon cancer in an inguinal hernia sac associated with an abdominal wall abscess: a case report

Abstract

Background: An inguinal hernia is a common disease; however, a malignant tumor within the inguinal hernia sac is rare, and perforated colon cancer in the hernia sac is extremely rare.

Case presentation: A 73-year-old man presented to our hospital with high fever and painful bulging of the lower abdomen. Computed tomography showed air-containing fluid in the abdominal wall, as well as localized wall thickness of the sigmoid colon in the left groin. An emergency operation revealed a huge subcutaneous abscess and a hard mass of the sigmoid colon within an indirect inguinal hernia sac. Sigmoidectomy and hernia repair using the Marcy method were performed. Lymph node dissection was performed through a transrectal abdominal incision. Histopathological examination of the resected specimen revealed moderately differentiated adenocarcinoma invading the serosal layer with lymph node metastasis.

Conclusions: Incarcerated inguinal hernia with perforated colon cancer is rare; an emergent operation should accordingly be performed based on infection control, oncological principles, and secure hernia repair.

Keywords: Abscess; Colorectal cancer; Inguinal hernia.

Fig. 1

Appearance of the lower abdomen and groin on admission

Fig. 2

a, b Computed tomography scan showing air-containing fluid in the lower abdominal wall (arrow head), localized wall thickness of the sigmoid colon in the left groin (arrow), and (c) swollen lymph nodes along the IMA and abdominal aorta (arrow)

Fig. 3

Surgical views showing a large hernia sac (a, arrow) and segmental wall thickness of the sigmoid colon within the hernia sac (b, arrow head)

Fig. 4

a Macroscopic findings of the resected specimen showing a well-demarcated ulcerative protruding lesion. b Histological examination showed moderately differentiated adenocarcinoma invading the serosal layer (hematoxylin and eosin staining, x200)