Scrotal Enterocutaneous Fistula: A dilemma of Long-Standing untreated Inguinal Hernia (original) (raw)
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CASE REPORT Enterocutaneous Fistula of the Scrotum
Inguino-scrotal hernia is a very common surgical entity. Though much common in pediatric population, yet no age is exempted. The diagnosis and management is also prompt in expert surgical hands. The incarceration of inguinal hernia in children varies between 5 to 23.6% in many series and is more frequent in neonates and infants. Incarceration and strangulation is more common in developing countries probably due to not so good health care infrastructure and health education amongst the comparatively less educated population (1,2,3,4).The scrotal enterocutaneous fistula following incarceration/ strangulation of inguino-scrotal hernia is beyond doubt the very rare complication even in the developing world. (5,6).Due to rarity of this surgical entity we present here two very rare case of scrotal enterocutaneous fistula one following intervention by a surgeon misdiagnosing strangulated inguinoscrotal hernia in a 65 years old male and another 40 years male from very low socio-economic Abstract Inguino-scrotal hernia is a very common surgical entity. Though much common in pediatric population, yet no age is exempted. Enterocutaneous fistula in an inguino-scrotal hernia is a very rare surgical entity in both developing as well as developed countries. Comparatively commoner in pediatric age group but no age is exempt, the information gathered from few cases available in the surgical literature. About 08 cases in pediatric age group and 06 cases in adult population are available in the literature that could be revealed from Pubmed/Medline as well as medical library shelf search. We report here two rare cases of scrotal enterocutaneous fistula in an adult in inguinoscrotal hernia.
A complicated true sliding hernia presenting as a spontaneous enteroscrotal fistula in an adult
Journal of Emergencies, Trauma, and Shock, 2010
Diffuse guarding, rigidity, and a tympanic abdomen pointed towards peritonitis. The scrotal area was found to be stained with greenish material with fecal odor. A closer examination revealed fecal material flowing out of an opening at the root of the right scrotum, the surrounding skin being inflamed and macerated.[Figure 1] The inguinal hernia on the right side was tense, tender, irreducible and had a doughy consistency. The patient was immediately resuscitated with 2 liters of Ringer lactate with two large bore 16G catheters and reassessed in one hour when the patient's blood pressure improved to 106/74 mmHg. The patient was given 2g intravenous ceftriaxone, 500mg amikacin, and 500mg metronidazole. The patient's initial blood parameters showed hemoglobin of 8 g/dl, total leukocyte count 16500 cells/mm 3 , serum urea (48mg/dl), serum creatinine (0.8mg/dl), serum sodium, potassium 132 and 3.5 mEq/L, respectively. A plain abdominal radiograph of the abdomen revealed pneumoperitoneum. Further radiological investigations were limited to an ultrasound in the Emergency department showing free intraperitoneal air and fluid along with the confirmation of bowel loops in the inguinal hernia. Dye studies to identify the source of the fistula were withheld as the obstructed bowel contents in the strangulated inguinal hernia was the obvious source of the fecal fistula and the patient was planned for exploration. One unit of fresh whole blood was transfused prior to surgery. The patient underwent exploratory laparotomy through a vertical midline incision that revealed moderate amount of pus and dirty flakes contaminating the peritoneal cavity. The caecum with the appendix had traversed through right inguinal canal to lie in the scrotum. The caecum had
Surgical Science, 2019
We report a case of grave and rare surgical complications nowadays, which calls out to us on the necessity of a bigger raising sensitization on the coverage of the constrictions hernial at the adult. It is about a case of right inguino-scrotal hernia choked secondarily complicated with a scrotal coecostomie at a 64-year-old man. The delay in the care was in touch with a traditional treatment but also in the poverty of the patient which was a needy the total care of which was assured by the social services department of the hospital. The perioperative exploration found a cecostomy the mucous membrane of which was inverted in the opening of the stoma, an ulceration of the peristomial scrotum with a normal macroscopic aspect of the testicle homolateral. The care was made at single time: parage and scrotal suture more resection segmental of the coecum followed by an anastomosis ileocolic terminoterminal and a cure of the hernia according to Shouldice. The operating suites were simple with ablation of the threads to operating J12 comment and the liberation of the patient the next day. The clinical evolution was satisfactory with a backward movement of 4 years.
A rare encounter of obstructed direct inguinal hernia
Journal of Society of Surgeons of Nepal
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 reinforcemen...
Living with a giant inguinoscrotal hernia for 35 years—a case report
Journal of surgical case reports, 2021
In this modern era, giant inguinoscrotal hernias are very rare to experience in a medical career. We discuss a case of a 65-yearold man with a history of an inguinoscrotal hernia with progressive growth for the past 35 years. On examination, he had a 20 cm × 15 cm non-reducible swelling with multiple ulcers over the skin surface extending to the mid-thigh with otherwise no other bladder and bowel complications. These large hernias pose a different set of surgical problems. Open surgery was performed, hernial sac opened, contents reverted and left orchidectomy were done with scrotal reconstruction. The defect was closed with Vicryl 1-0 over the muscle layer and the skin was stapled. Daily wound care was provided. Besides, this case also compels us to explore possible reasons for the occurrence of such potentially dangerous surgical problems in low-to-middle income countries (LMIC).
A Rare Case of Left Inguinoscrotal Hernia Containing Stomach
Cureus
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.
Massive Inguinal Hernia- a Rare Presentation of Common Disease
Zenodo (CERN European Organization for Nuclear Research), 2020
An inguinoscrotal hernia refers to a condition in which the fat or intestinal tissue push through the abdominal weakness of inguinal canal of either side. [1] We reported a case of 60-year-old man with right scrotal swelling reaching to the level of knees. Ultrasound abdomen confirmed the presence of all intestines in the scrotum.
Gastric strangulation and perforation caused by a giant inguinal-scrotal hernia
Acute abdomen is always a challenging case presentation in an emergency department. A thorough clinical examination and prompt differential diagnosis and required investigations can save patients from potentially life-threatening conditions. We report the case of a 49-year-old gentleman who presented with a rare presentation of acute lower abdominal pain which initially mimicked renal colic (flank pain and dysuria), later as an upper gastrointestinal bleed manifested by massive hematemesis due to the stomach being pulled down into a giant inguinoscrotal hernia resulting in a gastric perforation. The patient underwent life-saving emergency midline open laparotomy. To our knowledge and as per the literature reviewed, this is an uncommon presentation of an acute lower abdomen pain wherein the gastric perforation due to a giant inguinoscrotal hernia masquerade as renal colic and posed a diagnostic challenge to the treating emergency physician.
An Incarcerated Inguinal Sigmoid Hernia Case Report with Large Bowel Obstruction
BioRes Scientia , 2024
Abstract Background: Inguinal hernia is a term used to describe a protrusion of the peritoneum in the inguinal region, either with or without other contents. It's rare to find a sigmoid inguinal hernia. Case Report: A 75-year-old patient presented with symptoms and signs consistent with large bowel obstruction. For four years, he also had a reducible swelling in his right inguinal and epigastric regions, but after four days, it stopped being reducible. Due to a prior trans vesical prostatectomy, a large bowel post-operative adhesion was taken into consideration. The patient's x-ray revealed complete large bowel obstruction. An incarcerated sigmoid colon right inguinal hernia and omental epigastric hernia were found after entering the abdomen through a vertical mid-abdominal incision. The viable sigmoid colon and momentum from each hernia were then reduced, respectively. After completing a modified Bassini procedure using separate inguinal incisions for an inguinal hernia and direct repair for an epigastric hernia, the patient was discharged after 48 hours. The epigastric hernia repair was done because it was on the vertical abdominal incision site. Conclusion: Large bowel inguinal hernias are not common, but it's crucial to consider large bowel obstruction when there are suggestive x-ray features, like our patient. Keywords: incarceration; hernia; obstruction
Reduction En-masse of Inguinal Hernia with Incarcerated Bowel: Report of a Rare Case
American Journal of Case Reports
Rare disease Background: Reduction en-masse of an inguinal hernia is a very uncommon condition in which a hernia sac migrates into the preperitoneal space containing an incarcerated bowel loop. Case Report: A 76-year-old male patient with a 4-year history of reducible left inguinal hernia complained of abdominal pain for 2 h before admission. Contrast-enhanced computed tomographic (CT) images revealed a small bowel obstruction with dilatation from the distal jejunum to the proximal ileum and a closed-loop obstruction showing a 6.2-cm oval-shaped sac in the preperitoneal space. Conclusions: Diagnosis of reduction en-masse of inguinal hernia is often challenging due to the infrequency of its occurrence, although it has specific CT findings. The present case report suggests that clinical and radiological awareness are very important for accurate diagnosis and management in patients with reduction en-masse of an inguinal hernia.