P-016 SMALL BOWEL PERFORATION WITHIN A GIANT INGUINOSCROTAL HERNIA DUE TO AN INGESTED FOREIGN BODY

Abstract

Abstract Introduction Bowel perforation due to an ingested foreign body is a rare event. Its presentation within an inguinoscrotal hernia, is even more uncommon. Case Description We report the case of a 69-year-old indigent man with a chronic alcoholic liver disease history, who presented in the emergency department due to sepsis. He was complaining of nausea, vomiting and mild abdominal pain. Clinical examination revealed a painful, giant right inguinoscrotal hernia, with cutaneous trophic changes and subcutaneous emphysema. Blood test showed leukocytosis and lactic acidosis. CT scan revealed small bowel perforation with peritonitis inside the hernia sac. The patient underwent emergency surgery. Two 5-centimeters long fishbones were found. Ileocecal resection with ileocolic side-to-side anastomosis and Lichtenstein hernioplasty open repair were performed. A polypropylene mesh was placed. Discussion Accidental foreign body ingestion followed by gastrointestinal tract perforation is a rare cause of peritonitis. There are few case reports about this event happening inside a hernia. Perforation is more common at points of physiological angulation or narrowing of the passage within the digestive tract, such as lower esophageal sphincter, pylorus or ileocecal valve. Inguinoscrotal hernias present as a pathologic stenotic area where foreign bodies can produce an obstruction or perforation. In these cases, the hernia repair is challenging due to the contaminated scenario. Conclusion The diagnosis of perforation within an inguinal hernia should be suspected in cases of acute abdomen and incarcerated hernia, in order to choose the best surgical treatment option.