Total Colon “Collapse” in Giant Left-Sided Inguino-Scrotal Hernia: Double-Mesh Plastic Repair

Abstract

Giant inguino-scrotal hernias are those that extend below the midpoint of the inner thigh when the patient is in the standing position. There are three specific problems with management of these giant inguinal hernias: the “loss of domain” of the bowel, the high risk for recurrence, and the residual exuberant scrotal skin. A fundamental part in the treatment of patients with large hernias is represented by a careful preoperative investigation using MR and, if necessary, CT scan to exclude neoplastic pathology in the context. In this article, we describe the case of an obese patient suffering from Von Recklinghausen syndrome carrying a giant left inguino-scrotal hernia. A wide left inguinotomy partially extended to the scrotum was performed. In the hernia sac, the colon was completely collapsed and floating as it was entirely free from any intra-abdominal anatomic anchoring points. After a radical needful omentectomy, the trasversalis fascia and the internal inguinal ring were reconstructed with a polypropylene mesh placed in the pre-peritoneal-retro muscular space. A second wider polypropylene mesh was positioned above the muscular abdominal plane fixed to the pubic tubercle.