Abstract
Complicated inguinal hernia is a common surgical emergency. Rarely, hernias may pose a great surprise and complexity in their management.We report a 55 year old gentleman witha long standing history of irreducible right inguinal hernia who presented in shock with sudden increase in size of scrotum and obstipation for 1 day.A diagnosis of strangulated inguinal hernia was made and the patient was taken up for emergency surgery.On exploration the content in the sac was normal small bowel and faeculant smelling fluid. Abdomen was explored for inspecting the proximal bowel and to facilitate reduction of contents.But as a surprise small bowel volvuluswith gangrenous bowel was noted. Resection and anastomosis was done.This paper stresses the importance of having a high index of suspicion in all cases of strangulated hernia of a concomitant small bowel volvulus as its recognition and early surgical intervention is paramount in reducing the mortality associated with it.
Highlights
Volvulus is a rare cause of small bowel obstruction, with the majority of cases occurring in sigmoid colon
Inguinal hernias are relatively common in the elderly with an estimated prevalence 6%.Incarceration of inguinal hernia occurs in approximately 10% of cases which in turn can lead to strangulationwith potentially lethal sequelae
Strangulated hernia may be complicated by volvulus of an intra-abdominal oral loop; there may be a volvulus, one loop of which finds its way into the hernia sac to become incarcerated and simulate strangulation or to become strangulated, or, again, the torsion may occur within or just above the neck of the sac.[3]
Summary
Volvulus is a rare cause of small bowel obstruction, with the majority of cases occurring in sigmoid colon. Small bowel volvulus can be worrisome if not diagnosed early. Between 9-35%, and even higher in late presentation.1The strangulated inguinal hernia on the other hand is one of the most common emergencies in surgery, which occurs in approximately 1–3% of groin hernias.The sac of an inguinal hernia most frequently contains the intestine and the omentum and uncommonly the appendix, the Meckel diverticulum, the ovary or the urinary bladder. Volvulus may produce in a hernia signs and symptoms which accurately simulate hernial strangulation; or it may be associated with actual strangulated hernia. In either association, may readily escape recognition; and that probably contributes heavily to the mortality of strangulated hernia.[3]
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