A Rare Case of Left Inguinoscrotal Hernia Containing Stomach

Abstract

This is the case of a 71-year-old male who presented to the emergency department with the chief complaint of left inguinoscrotal swelling and pain. The patient stated that he had nausea, vomiting, and constipation for a few weeks prior to the presentation. He also reported that he had a reducible, asymptomatic left inguinal hernia for the past 20 years. He began to experience pain in the left groin related to the hernia recently. During the past two weeks, he was having liquid bowel movements, and his last bowel movement occurred the morning of presentation. The patient did not report any fevers, chills, shortness of breath, or chest pain. His physical examination was remarkable for left lower quadrant fullness and mild abdominal distension. A large incarcerated left inguinoscrotal hernia was present, which markedly displaced and engulfed his penis. The patient was taken to the operating room for open inguinal hernia repair with mesh, where stomach and small bowel were encountered within the hernia sac. There was no ischemia noted, thus we repaired the hernia with mesh. The patient tolerated the procedure well and progressed postoperatively without incident. He was successfully discharged on postoperative day one. This case and literary review is a reference to the practicing general surgeon treating an incarcerated hernia containing the stomach.

Keywords: acute care surgery and trauma; emergency general surgery; incarcerated hernia; inguinal hernia repair; stomach.

Figure 1. Large left inguinoscrotal hernia engulfing penis.

Figure 2. Computed tomography of abdomen and pelvis showing dilated stomach extending into the low pelvis.

Arrow pointing to the dilated stomach extending into the low pelvis.

Figure 3. Computed tomography of abdomen and pelvis sagittal cross section showing dilated stomach extending into the left inguinal hernia.

Arrow pointing toward dilated stomach measuring 109 mm in depth.

Figure 4. Computed tomography of abdomen and pelvis coronal cross section showing dilated stomach extending into the left inguinal hernia.

Arrow pointing to incarcerated left inguinal hernia containing stomach.

Figure 5. Computed tomography of abdomen and pelvis showing dilated stomach within left inguinal hernia sac.

Arrow pointing toward stomach within left inguinal canal.

Figure 6. Image showing the final incision after surgery on postoperative day one.