EP-25 Double Gastric Outlet Obstruction Caused by an Incarcerated Right Inguinal Hernia, a Rare Presentation

Abstract

Abstract We report a case of an 84-year old man who presented with double gastric outlet obstruction from an incarcerated right inguinal hernia that contained part of the stomach, most of the small bowel, omentum, appendix, caecum, ascending and transverse colon, causing a double gastric outlet obstruction. Several intra-abdominal organs have been reported in groin hernias including the appendix, bladder, small and large bowel and ovaries. There are approximately 60 cases of inguinal hernias containing the stomach, the majority were before 1980. It's believed that the emphasis of early repair minimized the occurrence of complications and decreased presentations of these cases. Two cases were published in the UK with a similar condition in 2014 of which one was treated conservatively and the other had an open inguinal hernia repair with mesh. He presented to the emergency department with a 1 day history of severe abdominal pain and dark brown vomiting due to incarceration of inguino-scrotal hernia which he had for the last 24 years with no symptoms. His abdomen was soft and non-tender with large right inguino-scrotal hernia which was tender on palpation and irreducible. The diagnosis was confirmed with a CT scan. The P-Possum score was calculated, 2.56% mortality and 49.5% morbidity. He was taken to the theatre, after resuscitation for exploratory laparotomy, omentectomy and inguinal hernia Lichtenstein repair with Vicryl® mesh. At the end, it is thought that long-standing traction on the greater omentum and its attachments may be responsible for the descent of the stomach into the hernia sac.