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Strangulated inguinal hernia due to an omental band adhesion within the hernial sac: a case report.

Nachimuthu S, Gergely S - Cases J (2009)

Bottom Line: Usually the narrow internal inguinal ring or the external inguinal ring is the site of constriction of the viscus, which forms the content of the hernia resulting in strangulation.A 56-year-old Caucasian gentleman presented to us with a 6 hours history of non-reducible tender lump in his right groin.Resection of the gangrenous small bowel and primary anastomosis can be safely performed through the same inguinal incision.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Hinchingbrooke Hospital, Hinchingbrooke Healthcare NHS Trust, Huntingdon, Cambridgeshire, UK. szabolcs.gergely@hinchingbrooke.nhs.uk.

ABSTRACT

Introduction: Strangulated Inguinal hernia is one of the most common surgical emergencies dealt with by surgeons worldwide. Usually the narrow internal inguinal ring or the external inguinal ring is the site of constriction of the viscus, which forms the content of the hernia resulting in strangulation. We report a rare case of strangulated inguinal hernia where the constricting element is not the internal or external inguinal ring, but an omental band adhesion causing closed loop small bowel obstruction and gangrene within the hernial sac in the inguinal canal.

Case report: A 56-year-old Caucasian gentleman presented to us with a 6 hours history of non-reducible tender lump in his right groin. His groin was explored urgently under general anaesthesia and was found to have an omental band adhesion causing closed loop small bowel obstruction with gangrene within the hernial sac in the inguinal canal with a wide internal inguinal ring. Gangrenous small bowel was resected and primary anastomosis was performed through the same inguinal incision.

Conclusion: Strangulation of the inguinal hernial content is usually due to the tight constriction at the level of internal inguinal ring or at external inguinal ring. Uncommonly strangulation of the contents can occur due to other causes like omental band adhesion. Anyone presenting with clinical features of strangulated inguinal hernia with small bowel obstruction mandates prompt exploration of the inguinal canal. Although it may not change the treatment approach, one should be aware about this special entity. Resection of the gangrenous small bowel and primary anastomosis can be safely performed through the same inguinal incision.

No MeSH data available.


Related in: MedlinePlus

Plain abdominal x-ray. Distended small bowel loops consistent with small bowel obstruction.
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Figure 1: Plain abdominal x-ray. Distended small bowel loops consistent with small bowel obstruction.

Mentions: A 56 year old Caucasian gentleman presented with a six hour history of a non-reducible tender lump in his right inguinal region. He was known to have bilateral inguinal hernia for the past three months and was waiting for an elective repair. His past medical history includes systemic hypertension for which he is on anti-hypertensive medications. There is no history of previous abdominal operations or any episodes of abdominal sepsis. On clinical assessment, his temperature was 37.5 degree Celsius, heart rate was 90 beats per minute and blood pressure was 130/90 mm of Hg. Local examination revealed a 15 cm × 7 cm sized non-reducible tender swelling in his right inguinal region with no cough impulse. Contralateral side revealed a non-tender, reducible inguinal hernia. Examination of the abdomen revealed mild distension. Blood biochemistry results were as follows: Haemoglobin 14.5 gm/dl, White cell count 25,000 cells/mm[3], Neutrophil count 22,500 cells/mm[3], Urea 4.0 mmol/L, Creatinine 68 mmol/L, Potassium 4.0 mmol/L, Sodium 135 mmol/L, C – Reactive protein 67 mg/l. Plain abdominal x-ray showed multiple loops of distended small bowel seen centrally in the abdomen consistent with distal small bowel obstruction. (Figure 1) He was taken to the operation theatre urgently with a diagnosis of strangulated inguinal hernia and the right inguinal region was explored under general anaesthesia. Gangrenous small bowel of 20 cm with closed loop obstruction caused by a single omental band adhesion was noted. (Figure 2) The neck of the hernial sac at the level of the internal inguinal ring as such was found to be very wide. The omental band adhesion was divided and the gangrenous small bowel was resected and primary stapled anastomosis was performed through the same inguinal incision. The widened internal inguinal ring was narrowed and the posterior wall of the inguinal canal was repaired with sutures rather than mesh due to the presence of infection. The patient made an uneventful post-operative recovery and was discharged home on the third post-operative day. Histology of the resected specimen was reported as transmural infarction of the small bowel with viable resection margins and no evidence of intravascular thrombosis or vasculitis. He was followed up in the out-patient clinic four weeks later and found to have no problems and has been booked for an elective hernia repair on the contralateral side.


Strangulated inguinal hernia due to an omental band adhesion within the hernial sac: a case report.

Nachimuthu S, Gergely S - Cases J (2009)

Plain abdominal x-ray. Distended small bowel loops consistent with small bowel obstruction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2626576&req=5

Figure 1: Plain abdominal x-ray. Distended small bowel loops consistent with small bowel obstruction.
Mentions: A 56 year old Caucasian gentleman presented with a six hour history of a non-reducible tender lump in his right inguinal region. He was known to have bilateral inguinal hernia for the past three months and was waiting for an elective repair. His past medical history includes systemic hypertension for which he is on anti-hypertensive medications. There is no history of previous abdominal operations or any episodes of abdominal sepsis. On clinical assessment, his temperature was 37.5 degree Celsius, heart rate was 90 beats per minute and blood pressure was 130/90 mm of Hg. Local examination revealed a 15 cm × 7 cm sized non-reducible tender swelling in his right inguinal region with no cough impulse. Contralateral side revealed a non-tender, reducible inguinal hernia. Examination of the abdomen revealed mild distension. Blood biochemistry results were as follows: Haemoglobin 14.5 gm/dl, White cell count 25,000 cells/mm[3], Neutrophil count 22,500 cells/mm[3], Urea 4.0 mmol/L, Creatinine 68 mmol/L, Potassium 4.0 mmol/L, Sodium 135 mmol/L, C – Reactive protein 67 mg/l. Plain abdominal x-ray showed multiple loops of distended small bowel seen centrally in the abdomen consistent with distal small bowel obstruction. (Figure 1) He was taken to the operation theatre urgently with a diagnosis of strangulated inguinal hernia and the right inguinal region was explored under general anaesthesia. Gangrenous small bowel of 20 cm with closed loop obstruction caused by a single omental band adhesion was noted. (Figure 2) The neck of the hernial sac at the level of the internal inguinal ring as such was found to be very wide. The omental band adhesion was divided and the gangrenous small bowel was resected and primary stapled anastomosis was performed through the same inguinal incision. The widened internal inguinal ring was narrowed and the posterior wall of the inguinal canal was repaired with sutures rather than mesh due to the presence of infection. The patient made an uneventful post-operative recovery and was discharged home on the third post-operative day. Histology of the resected specimen was reported as transmural infarction of the small bowel with viable resection margins and no evidence of intravascular thrombosis or vasculitis. He was followed up in the out-patient clinic four weeks later and found to have no problems and has been booked for an elective hernia repair on the contralateral side.

Bottom Line: Usually the narrow internal inguinal ring or the external inguinal ring is the site of constriction of the viscus, which forms the content of the hernia resulting in strangulation.A 56-year-old Caucasian gentleman presented to us with a 6 hours history of non-reducible tender lump in his right groin.Resection of the gangrenous small bowel and primary anastomosis can be safely performed through the same inguinal incision.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Hinchingbrooke Hospital, Hinchingbrooke Healthcare NHS Trust, Huntingdon, Cambridgeshire, UK. szabolcs.gergely@hinchingbrooke.nhs.uk.

ABSTRACT

Introduction: Strangulated Inguinal hernia is one of the most common surgical emergencies dealt with by surgeons worldwide. Usually the narrow internal inguinal ring or the external inguinal ring is the site of constriction of the viscus, which forms the content of the hernia resulting in strangulation. We report a rare case of strangulated inguinal hernia where the constricting element is not the internal or external inguinal ring, but an omental band adhesion causing closed loop small bowel obstruction and gangrene within the hernial sac in the inguinal canal.

Case report: A 56-year-old Caucasian gentleman presented to us with a 6 hours history of non-reducible tender lump in his right groin. His groin was explored urgently under general anaesthesia and was found to have an omental band adhesion causing closed loop small bowel obstruction with gangrene within the hernial sac in the inguinal canal with a wide internal inguinal ring. Gangrenous small bowel was resected and primary anastomosis was performed through the same inguinal incision.

Conclusion: Strangulation of the inguinal hernial content is usually due to the tight constriction at the level of internal inguinal ring or at external inguinal ring. Uncommonly strangulation of the contents can occur due to other causes like omental band adhesion. Anyone presenting with clinical features of strangulated inguinal hernia with small bowel obstruction mandates prompt exploration of the inguinal canal. Although it may not change the treatment approach, one should be aware about this special entity. Resection of the gangrenous small bowel and primary anastomosis can be safely performed through the same inguinal incision.

No MeSH data available.


Related in: MedlinePlus