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Case Reports
. 2025 Apr 15;17(4):e82279.
doi: 10.7759/cureus.82279. eCollection 2025 Apr.

The Stone Within: A Rare Case of an Incarcerated Inguinal Hernia With a Giant Fecaloma

Filipe Ramalho de Almeida  1 , Joana Frazão  1 , Rita Pera  1 , João Guimarães  2   3
Affiliations
Case Reports

The Stone Within: A Rare Case of an Incarcerated Inguinal Hernia With a Giant Fecaloma

Filipe Ramalho de Almeida et al. Cureus. .

Abstract

Chronic constipation can lead to severe complications, including the formation of fecalomas, which may result in intestinal obstruction. Inguinal hernias, among the most prevalent abdominal wall hernias, can become incarcerated, leading to obstruction and ischemia. However, the occurrence of an incarcerated inguinal hernia containing a fecaloma is exceedingly rare. We present a case of a 72-year-old male who presented with a progressively enlarging left inguinal mass, urinary incontinence, and chronic diarrhea. Imaging studies revealed a significantly large left inguinoscrotal hernia containing the sigmoid colon impacted by a 4-kg fecaloma. Attempts at conservative disimpaction were unsuccessful, necessitating surgical intervention. The patient underwent a sigmoid colectomy with side-to-end colorectal anastomosis, hernia repair with prosthetic reinforcement, and a diverting ileostomy. This case highlights the importance of tailored surgical approaches in managing uncommon complications stemming from chronic constipation.

Keywords: fecaloma; incarcerated inguinal hernia; inguinal-scrotal hernia; obstipation; sigmoid colon.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Patient presentation.
Figure 2
Figure 2. CT scan.
CT scan images, from cranial to caudal (A-D), show a voluminous (maximum diameter of 15 cm) inguinoscrotal hernia containing the sigmoid colon dilated and filled with a giant fecaloma. Mild mesenteric fat densification (arrowhead) is also noted inside the hernial sac and its pedicle. On the right inguinal canal, there is an additional hernia containing an ileal loop (arrow). The alterations cause the deformation and displacement of the bladder (*) to the right.
Figure 3
Figure 3. Intra-operative images.
A. Hernial sac after dissection and liberation from the scrotal sac. B. Scheme of the section area (red lines) (original schematic representation). C. Patient after surgery.
Figure 4
Figure 4. Anastomosis scheme.
A. Colon and rectum after sigmoid colectomy. B. Colorectal side-to-end anastomosis on the posterior face of the rectal stump using a GIA™ stapler (60-mm purple cartridge) (original schematic representation).
Figure 5
Figure 5. Surgical specimen.
See this image and copyright information in PMC

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