Abstract
BackgroundA carcinoma within a hernia in the groin is uncommon, with an incidence of less than 0.5 percent of all excised sacs. This article describes a case of synchronous colonic carcinomas, one of which presented as an inguinoscrotal mass.Case presentationA 69-year old man presented with a large, irreducible left inguinoscrotal hernia and symptoms of obstruction. On examination, there was an 8 cm palpable mass within the hernia sac. CT scan revealed small and proximal large bowel obstruction secondary to a large ingunoscrotal sac and synchronous colonic tumours of the transverse colon and the ascending colon. The former presented as an inguinoscrotal mass. Laparotomy revealed a large tumour mass arising from the transverse colon in the hernia sac. The procedure was followed by an extended right hemicolectomy, during which the second tumour in the ascending colon was also resected.ConclusionThis case demonstrates a rare but interesting occurrence of primary transverse colon carcinoma presenting in a hernia sac, in conjunction with a synchronous tumour of the ascending colon. Prognosis is comparable to patients with a solitary tumour of similar pathological staging when the resection is curative. The presence of an inguinal hernia itself does not signify an increased risk of colorectal malignancy. However, in the presence of obstruction, incarceration, and weight loss, malignancy should be suspected. Thorough clinical examination, flexible sigmoidoscopy or radiographic evaluation is necessary preoperatively in such patients. Surgical resection, with or without adjuvant oncological treatment, should be performed as soon as possible, using established techniques with modifications according to involvement of local structures.
Highlights
This case demonstrates a rare but interesting occurrence of primary transverse colon carcinoma presenting in a hernia sac, in conjunction with a synchronous tumour of the ascending colon
Prognosis is comparable to patients with a solitary tumour of similar pathological staging when the resection is curative
There is limited literature on the management of patients with malignancies in hernia sacs and we found no clear evidence on the best approach in treating these patients
Summary
The present case demonstrates a rare but interesting occurrence of primary transverse colon carcinoma presenting in a hernia sac, in conjunction with a synchronous tumour of the ascending colon. The presence of an inguinal hernia http://www.jmedicalcasereports.com/content/1/1/36 itself does not signify an increased risk of colorectal malignancy. Inguinal hernia alone is a relatively rare cause of colonic obstruction. The presence of symptoms of obstruction, incarceration, weight loss and a palpable mass within the hernia sac immediately raised the suspicion of malignancy. 8. Brendel TH, Kirsh IE: Lack of association between inguinal hernia and carcinoma of the colon. 9. Juler GL, Stemmer EA, Fullerman RW: Inguinal hernia and colorectal carcinoma. Gerson LB, Triadafilopoulos G: Is colorectal cancer screening necessary in the preoperative assessment of inguinal herniorrhaphy? The American Journal of Gastroenterology 2001, 96(6):1914-1917
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