A rare encounter of obstructed direct inguinal hernia

  • Amit Singh KATHMANDU UNIVERSITY
  • Nripesh Rajbhandari
  • Balaram Malla
  • Gakul Bhatta

Abstract

The direct inguinal hernia has a wider neck and thus usually doesn’t present as strangulation or incarceration in comparison to the indirect component. When direct inguinal hernias are untreated for a longer duration, they may get strangulated and incarcerated. Hence such long-standing direct hernias with features of intestinal obstruction and /or peritonism should be promptly seen and diagnosed to prevent massive and unwanted intestinal resection. We are reporting a case of 83-year-old male presented to Surgical Emergency Department of Dhulikhel Hospital, Kathmandu University hospital with complaints of swelling in the right inguinoscrotal region for 12 years and progressed to become irreducible and painful for 12 hours. Clinically he had an acute intestinal obstruction. Intra-operatively we found a direct hernia containing congested small bowel loops and toxic fluids.  The toxic fluid was suctioned and after confirming viability, modified Bassini’s repair was done with reinforcement of the posterior wall.
Even direct inguinal hernia of longer duration can cause acute or sub-acute intestinal obstruction with or without features of peritonism. This complication is more common in elderly patients.

References

1. Jenkins JT, O’Dwyer PJ. Inguinal hernias. BMJ. 2008 Feb 2;336(7638):269-72.
2. McIntosh A, Hutchinson A, Roberts A, Withers H. Evidence-based management of groin hernia in primary care--a systematic review. Fam Pract. 2000 Oct;17(5):442–7.
3. Gould J. Laparoscopic versus open inguinal hernia repair. Surg Clin North Am 2008 Oct;88(5):1073–81, vii–viii.
4. Zinner MJ, Ashley SW. Maingot's Abdominal Operations, 12ed. New York: McGraw Hill Education; 2012
5. Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz’s Principles Of Surgery, 10ed. New York: McGraw Hill Education; 2014. p. 1496.
6. Kulacoglu H, Kulah B, Hatipoglu S. Coskun F. Incarcerated direct inguinal hernias: a three-year series at a large volume teaching hospital. Hernia. 2000 Sep;4(3):145–7.
7. Álvarez JA, Baldonedo RF, Bear IG, Solís JAS, Álvarez P, Jorge JI. Incarcerated groin hernias in adults: Presentation and outcome. Hernia. 2004 May;8(2):121-6.
Published
2020-01-13
How to Cite
SINGH, Amit et al. A rare encounter of obstructed direct inguinal hernia. J Soc Surg Nep, [S.l.], v. 22, n. 2, p. 41-43, jan. 2020. ISSN 2392-4772. Available at: <http://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=324>. Date accessed: 04 apr. 2020.