Abstract
There are few reports of a transverse colon inguinal hernia; furthermore, an inguinal hernia perforating the scrotum is rare. Here we report the case of a 79-year-old man who died after developing an incarcerated colon inguinal hernia that perforated the scrotum and exhibited an air-fluid level. The patient was referred to our hospital in November 2011 with a complaint of inability to move. Physical examination revealed an abnormally enlarged left scrotum and cold extremities. He reported a history of gastric cancer that was surgically treated more than 30 years ago. His white blood cell count and C-reactive protein level were elevated. Abdominal and inguinal computed tomography revealed that his transverse colon was incarcerated in the left inguinal canal. Free air and air-fluid level were observed around the transverse colon, suggestive of a perforation. The patient and his family refused any surgical intervention; therefore, he was treated with sultamicillin tosilate hydrate and cefotiam hydrochloride. However, he succumbed to panperitonitis 19 days after admission. The findings from this case indicate that the transverse colon can perforate into an inguinal hernia sac.
Highlights
Inguinal hernia is a common problem in adults, and obstruction and strangulation are the most serious complications [1]
Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal structures herniate through a weak spot in the fascia of the posterior wall of the inguinal canal, which is formed by the transversalis fascia
Indirect inguinal hernias occur when abdominal structures protrude through the deep inguinal ring, lateral to the inferior epigastric vessels; this may be caused by the failure of embryonic closure of the processus vaginalis [2]
Summary
Inguinal hernia is a common problem in adults, and obstruction and strangulation are the most serious complications [1]. There are two types of inguinal hernia, direct and indirect, which are defined by their relationship to the inferior epigastric vessels. Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal structures herniate through a weak spot in the fascia of the posterior wall of the inguinal canal, which is formed by the transversalis fascia. Indirect inguinal hernias occur when abdominal structures protrude through the deep inguinal ring, lateral to the inferior epigastric vessels; this may be caused by the failure of embryonic closure of the processus vaginalis [2]. Hernias are more common in men than in women. The lifetime risk of developing inguinal and femoral hernias is approximately 25% in men and less than 5% in women. An inguinal hernia rarely perforates into the scrotum. We report a rare case of an inguinal incarcerated hernia that perforated the scrotum and exhibited an air-fluid level
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