Carcinoma of the Colon Occurring in an Inguinal Hernia

Abstract

The presence of tumours within hernial sacs has been reported by a number of authors (Pagliani, 1937; Zimmerman, 1940; Oppenheimer, 1943). However, despite the frequency of carcinoma of the colon in surgical practice, its presence in a hernial sac is of extreme rarity. A review of the literature reveals only two reported instances. Gerhardt (1938) described the successful removal of a scirrhous adenocarcinoma of the upper sigmoid colon with an associated abscess in a left inguinal hernia, the diagnosis, in this instance, being determined at operation. Fieber and Wolstenholm (1955) recorded a further case of colonic tumour in a hernial sac, the patient being admitted with an obstructed left inguinal hernia. A radiograph of the abdomen revealed dilated loops of small and large bowel, the gas terminating in the sigmoid colon. A barium enema showed narrowing of the lumen of the sigmoid colon within the hernial sac. At operation the true nature of the hernial contents was disclosed. A mass of inflammatory tissue surrounded the incarcerated loop of sigmoid colon and, in the most dependent portion of the loop, a firm annular mass was felt. This was subsequently shown, histologically, to be an adenocarcinoma with invasion of the wall of the hernial sac. The authors wish to place on record a further example of this rare combination of tumour within a hernia. In this instance the diagnosis was suggested pre-operatively. B.P., aged 66 years, was admitted on 22.8.56 with symptoms suggestive of a carcinoma of the colon.