Repair of a Giant Inguinal Hernia

Abstract

We report a case of a giant inguinal hernia (GIH) that underwent open surgical repair with mesh. The patient had a massive transcompartmental redistribution of abdominal contents from the abdominopelvic cavity to the hernia sac in the scrotum, with subsequent effects on the mechanical nature of the abdominal wall muscles. Repair of this type of giant hernia is challenging as it can raise the intra-abdominal pressure, therefore increasing the risk of abdominal compartment syndrome (ACS). The large size and chronicity of the hernia, associated with deranged mechanical forces/properties of the abdominal wall, made the management of this complex case unique and interesting. In similar cases of massive incisional or ventral hernias, the term "loss of domain" (LOD) is used. In such types of massive hernias, it is important to carefully plan and monitor for adverse physiological effects associated with increased abdominal pressure.

Keywords: abdominal compartment syndrome; giant inguinal hernia; intra-abdominal pressure; loss of domain.

Figure 1. Physical exam (standing) demonstrating a giant inguinoscrotal hernia

Figure 2. CT scan of the abdomen and pelvis (sagittal view) demonstrating massive scrotal contents

Figure 3. Foley catheter in place, prior to skin incision

Figure 4. Hernia contents including most of the small bowel, colon, and omentum

Figure 5. Large hernia sac prepared for excision and high ligation, after reduction of hernia contents

Figure 6. Gross picture of excised hernia sac and omentum

Figure 7. Completed hernia repair with prolene mesh

Figure 8. Finished repair with Jackson Pratt drain in the scrotum

Figure 9. Five-month follow up